Background to this inspection
Updated
9 October 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 18 August 2015 and was unannounced. The inspection was carried out by three inspectors and a specialist advisor with experience in dementia care and complex healthcare issues.
This was a comprehensive inspection which included follow-up of progress on the non-compliance
identified in the reports of the previous inspection on 8 and 10 December 2014 and the progress identified at the ‘Warning Notice’ follow-up inspection on 11 May 2015. Where applicable we have referred back to these previous inspections to report the progress made since those visits.
Prior to the inspection we reviewed the records we held about the service, including the details of any safeguarding events and statutory notifications sent by the provider. Statutory notifications are reports of events that the provider is required by law to inform us about.
We contacted the local authority care commissioners to obtain feedback from them about the service. During the inspection we spoke with nine staff and the general manager who has applied to become the registered manager. We also spoke with ten people using the service, four relatives and a visiting community nurse. We used the Short Observational Framework for Inspection (SOFI) as well as observing care informally during the inspection. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed the care plans and/or associated records for 18 people, including risk assessments and reviews, and related this to the care observed. We examined a sample of other records to do with the home’s operation including staff records, complaints, surveys and various monitoring and audit tools. We looked at the recruitment records for four recently appointed staff.
Updated
9 October 2015
This inspection took place on 18 August 2015 and was unannounced. This was a comprehensive inspection which included follow-up of progress on the non-compliance identified in the reports of the previous inspection on 8 and 10 December 2014 and at the ‘Warning Notice’ follow-up inspection on 11 May 2015.
At the previous comprehensive inspection we identified non-compliance against Regulations 9 (Care and welfare of service users), 10 (Assessing and monitoring the quality of service provision), 12 (Cleanliness and infection control), 13 (Management of medicines), 14 (Meeting nutritional needs), 18 (Consent to care and treatment), 20 (Records), 21, (Requirements relating to workers) and 22 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
From April 2015, the 2010 Regulations were superseded by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider was meeting the requirements of the comparable current regulations. Regulations 9 (Person-centred care), 17 (Good governance), 12 (Safe care and treatment), 14 (Meeting nutritional and hydration needs), 11 (Need for consent), 19 (Fit and proper persons employed) and 18 (Staffing).
The service provides care or nursing care to up to 103 older people, some of whom are living with dementia. The building is divided into two units. The ground and first floors (known as assisted living), accommodate people with care and nursing needs, some of whom may be living with the early stages of dementia. The second floor (known as reminiscence), accommodates people living with dementia. Communal areas are available for people on all floors. At the time of this inspection the service was supporting 83 people and a further two people were in hospital.
The service is required to have a registered manager but had not had one since the departure of the previous registered manager in May 2014. The current general manager was in the process of applying to become 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.
Significant improvements had been made in the areas previously highlighted to be of concern. Permanent staffing levels were improving and staff were more enthusiastic and motivated. People, relatives and staff reported positively on the changes made in the service and the new management. People felt safe and told us staff were more attentive and quicker to respond.
We saw that people’s care plans and associated records had improved and were now maintained up-to-date by regular interim updates in between reviews. Where people needed additional support around wound care, hydration or nutrition, this had been identified and records were used effectively to monitor changes. Medicines management was managed effectively and any errors or omissions were identified in a timely way so they could be addressed.
Support was sought from external health agencies and others in a timely way. The service had engaged with the local authority care home support team for advice and development. Where issues had arisen with external agencies the manager was actively addressing these. Staff training had improved and support through supervision, appraisal and regular meetings were all improving.
People were involved in planning their care and were encouraged to make decisions about their day-to-day care. People’s dignity, privacy and rights were protected. People’s consent was sought by staff before care was provided. A wide range of activities and opportunities for social interaction were provided and people’s views about the service were sought and acted upon.
The service was well led with staff knowing what was expected of them. The operation of the service was effectively monitored by the general manager and the registered provider and action was taken to address identified shortfalls.