On the day of our visit 42 people were using the service. They were supported by six care workers, a care leader, an activities co-ordinator, domestic and catering staff and the registered manager. We spoke with three people who used the service and five relatives. We also spoke with six members of care staff and the registered manager. The home offered residential and dementia care. The home is part of the Orders of St John Community Trust .We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
Is the service caring?
Is the service responsive?
Is the service safe?
Is the service effective?
Is the service well led?
This is a summary of what we found;
Is the service caring?
We found that people were supported by a caring service. We spoke with three people who used the service and five relatives visiting the home. They all spoke positively about the care. One person told us, 'Staff are nice and friendly. They treat people as individuals, like a human.' Throughout our visit we noted people were engaged in activities or tasks. For example, we saw a care worker reading a poem to a person who remained in bed. People had good interactions with care workers. One person told us, 'Staff are very good. I say what I want and they do it for me.' Another person told us, 'They do everything they can to make you comfortable. They are all nice, friendly and helpful".
We spoke with six care staff working in the home. One care worker told us' 'I am happy coming to work. I love looking after everyone.' During our visit we observed care workers interacting with people in a caring and respectful fashion. In particular we saw that people living with dementia were treated with consideration and patience. We saw care workers offering drinks to people. They crouched down to the person's level and made eye contact, showing them a cup and asking if they wanted a drink. This engaged people in a positive fashion and they responded with nods and smiles.
People's likes, dislikes and preferences were recorded and acted upon. One person had stated they liked soft toys and we saw a collection of soft toys in their room. Another stated they "like to attend religious services". Regular services were held and advertised on the activities board and we saw from the daily notes this person attended regularly.
Is the service responsive?
We found the service was responsive. For example, a care worker told us that a person who usually remains in bed has just been assessed for a new hoist and chair. They said, 'It will be lovely, they used to love going out into the garden and can't at the moment.' We saw the care plan for this person that showed the assessment had been completed and an equipment request made by the relevant health professional.
We saw minutes of "Residents and Relatives" meetings that were held at least twice a year. People were able to raise issues with the manager. We looked at the minutes for February 2014 and saw that one issue raised concerned the mobile shop. People had requested that the shop went around the home more frequently. We spoke with the manager about this who told us they were considering the options for the shop but would try to action this request. Another issue previously raised was a request for new televisions in the lounges. We noted that the provider had responded to this request and purchased two new televisions. This showed us that people's opinions were sought and acted upon.
Is the service safe?
We found that the service was safe. The provider planned and delivered care, treatment and support so that people were safe, their welfare was protected and their needs were met. Some people at the home had complex needs. These covered areas such as dementia, mobility, tissue viability and difficulties in swallowing. We saw that these complex needs were appropriately managed and all risk assessments were in place.
People were cared for in a clean, hygienic environment. We saw that all communal toilets, bathrooms, corridors and lounges were visibly clean and tidy. There were no unpleasant odours. There were suitable supplies of hand soap and paper towels available in bedrooms, toilets and bathrooms which meant that people and staff were provided with appropriate hand washing facilities.
The provider had effective recruitment and selection procedures in place. The provider checked, as far as possible, that care workers were of good character. The provider sought references from two sources, one being the previous employer. These were held in the files. Background checks were also conducted. All care workers had undergone checks by the Disclosure and barring Service (DBS) or the Criminal Records Bureau (CRB) and copies of these were held on file.
The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Care workers had received training in the mental Capacity Act (MCA). There were no people subject to a DoLS at the time of our inspection.
Is the service effective?
We found people were supported by an effective service. Care workers told us they received regular training. One care worker said, 'The training is good. I've done loads including, mental capacity, food hygiene, safeguarding, moving and handling". Another said, 'I had dementia training, it made such a difference, it really helped me interact with people with dementia".
One person we saw was at risk of choking and losing weight. A Malnutrition Universal Screening Tool (MUST) was used to assess and manage their condition. We saw they were weighed monthly and that they were maintaining their weight. A Speech and Language Therapist (SALT) assessment had recommended a pureed diet. We went to the kitchen and spoke with the chef. We saw the diet sheet for this person and noted the pureed diet highlighted. This was also highlighted on a wall chart that recorded special diets for people. The chef told us this person was soon to be reviewed again as they were doing so well and it was hoped they would soon be able to revert back to a normal, solid diet. This showed us that this person's care, treatment and support was effective.
Is the service well led?
We found the service was well led. The service required a registered manager and we saw that one was in place with the correct registration documentation.
We saw that complaints were managed and dealt with appropriately and details of how to make a complaint were clearly displayed around the home. Accidents and incidents were recorded and investigated. We saw that all accidents and incidents were appropriately managed and that any learning was shared. We looked at one that recorded a person was a frequent faller. The person was independent and mobile but liable to stand suddenly and fall. Care Home Support Services had been contacted and their recommendations had been followed. This included crash mats in the person's room and a referral to the occupational therapist. We saw that a meeting was held regarding the risk to this person and care workers had been briefed on the risks.
Audits were conducted and covered areas such as care, quality, infection and catering. Any actions resulting from the audit were recorded and carried forward. These were then dated and signed on completion. We also saw that monthly operational visits were conducted by the Area Operations Manager. All aspects of the service were covered by the visits and an ongoing action plan was used to highlight and resolve actions identified. One action we saw was regarding the need for a monthly falls analysis. A person was identified to deal with this action and a date for completion was set. We tracked this to the record for the following visit and saw that the action had been recorded as completed.