We inspected Four Seasons on 3, 12 and 19 June 2015. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.
Four Seasons is a care home which provides care for up to 72 people. It is divided into 3 separate buildings, with one providing nursing care and two providing residential care. The home provides care for people with dementia. At the time of the inspection 69 people used the service.
The home had a manager in place and they were in the process of applying to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We found that a range of stimulating and engaging activities were provided at the home. The two activities coordinators had linked into a wide range of local resources, which included clubs and societies as well as people who used the service who volunteered for a garden preservation society. People routinely went to these clubs. The registered provider had developed the garden and this was now fully accessible and people who used the service had vegetable patches as well as chickens. The activities coordinators had organised a choir, which people who used the service sang in and this group made a yearly demo record.
Each year people who used the service were supported to enter competitions such as the National Activities Programme Award and had won several national prizes. They had come third last year in the picnic competition; people who used the service and staff knitting a huge blanket and all joining in a large picnic. People and staff, on several occasions, had attempted to become Guinness Book of World Records holders. The activities coordinators and people who used the service used their skills and expertise to fund raise and had collected over £36000 this year. The people who used the service and relatives had determined how this was to be spent and decided that some would be allocated to renting transport whilst the remaining monies would be used to enrich the lives of the people who were unable to get out and about.
People told us that staff worked with them and supported them to continue to lead fulfilling lifestyles. Staff outlined how they supported people to continue to lead independent lives. For those people who lived with a dementia, we saw that staff matched their behaviour to people’s lived histories (the time of the person’s life they best recall) and this enabled individuals to retain skills and work to their full potential.
We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. Those people, who were able to, were encouraged and supported to go out independently and others routinely went out with staff.
People we spoke with told us they felt safe in the home and the staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.
People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. A nurse, two heads of care, two senior care staff and ten care staff were on duty during the day and a nurse, two senior care and eight staff on duty overnight. However, we noted that staff could be deployed more effectively across the three units to ensure support was readily available during the early morning and at mealtimes. The manager undertook to provide a floating twilight and dawn staff member as well as review mealtime practices.
We reviewed the systems for the management of medicines and found that people received their medicines safely.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home and saw that audits of infection control practices were completed.
Staff had received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia care. We found that the manager not only ensured staff received refresher training on all training on an annual basis but had introduced checks to make sure staff understood how to put this training into practice. Each month the manager questioned staff about different aspects of the courses and when staff struggled to find the correct answer they ensured staff received additional training.
Staff had a greater understanding of the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations. Staff had been working hard to ensure capacity assessments were completed in line with the Mental Capacity Act 2005 code of practice. They and the manager recognised that they were still developing the skills needed to always complete these accurately and they needed more space on the sections relating to people’s ability to take on board information to write their analysis.
People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.
Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best. We saw that when people lacked the capacity to make decisions staff routinely used the ‘Best Interests’ framework to ensure the support they provided was appropriate. We found that staff had also obtained information to confirm whether relatives had been appointed to the role of lasting power of attorney care and welfare and that these powers had been enacted or confirmed as in place.
People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.
People’s needs were assessed; care and support was planned and delivered in line with their individual care needs. The care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.
We saw that the registered provider had a system in place for dealing with people’s concerns and complaints. The manager had ensured people were supported to access independent advocates when needed. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.
The registered provider had a range of systems to monitor and improve the quality of the service provided. We saw that the manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.