We visited the home on 2 April 2014. We spoke with the manager, the operations director and five staff. People who lived at the home were not able to tell us how they were cared for because of their complex needs. However, we spoke with three relatives, looked at people's care plans and observed how people were cared for. Below is a summary of what we found. If you would like to see the evidence supporting our summary please read the full report.
Is the service safe?
The care plans we looked at showed that the nursing staff and manager assessed risks to people's health and well-being and their care plans included measures to minimise their identified risks. The manager arranged the staff rotas according to people's needs and additional staff worked during the periods when people most needed support.
The home had a policy and procedures related to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, although no applications needed to be submitted to the local authority. A registered mental health nurse assessed people's mental capacity to make decisions relating to their care and treatment. For those people who did not have capacity, their relatives and other health professionals were involved in making decisions in their best interests.
We found that systems were in place to ensure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Staff told us that the manager took action to minimise the risks of a re-occurrence.
Is the service effective?
People's health and care needs were assessed with them and their relatives, and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs were identified in people's care plans where required. We saw that people's care plans were reviewed every month and updated to reflect their changing needs.
Relatives we spoke with told us they could visit whenever they wanted to. They told us that staff were proactive and understood their relations' needs and preferences.
Staff attended mandatory training, such as, moving and handling, food hygiene and infection control. Nurses attended specialist training that was relevant to the needs of people living at the home. Staff told us the manager was very supportive. They told us they had regular team meetings and one to one meetings so they could discuss best practice and their personal development needs.
Is the service caring?
People were supported by kind and attentive staff. People were supported to complete a life history book, including a family tree, 'important people', my childhood, teenage years, working life and interests, so that staff could get to know them better.
We saw that care workers were patient and encouraging with people. Staff knew people well and understood their individual needs for practical support and companionship. Staff encouraged people to reminisce and talk about their own interests if they did not want to join in the group activities. A member of care staff told us, 'The afternoons are quieter, so we can chat with people, they tell us about their past, they are proud of their life and like telling us.'
Relatives told us that staff respected their relations and treated them as individuals.
People commented, 'The staff are friendly, I know them well. I go to relatives' meetings. They do listen.' People using the service and their relatives were encouraged to make suggestions and comments about the service at regular open meetings with the manager and activities coordinator.
Is the service responsive?
Staff asked other health professionals to visit people when they had concerns about their health. Staff recorded the health professionals' advice and the actions they took following their advice. This meant that people's response to treatment was monitored and could be changed appropriately. Staff we spoke with were knowledgeable about recent changes to people's treatments and described which treatments had been effective and which were ongoing.
Staff recorded when people saw their dentists, chiropodists and opticians, for example, so they could ensure that regular health checks were maintained. Relatives told us that they could read the daily records of care which assured them their relations received the care and support they needed. Relatives told us that the staff and manager responded appropriately when they had any concerns or issues. A relative told us, 'The manager addresses issues quickly, I'm impressed.'
Is the service well-led?
We found the service had an effective quality assurance system in place and identified actions had led to improvements in the service that people received. The manager carried out a regular programme of audits and checks to make sure the quality of the service was maintained.
The manager was supported by a care lead and clinical lead member of staff. All nurses were designated leads for different aspects of care or treatment, such as, tissue viability, mental health and infection control. Each lead nurse was supported by a team leader and care assistants. Staff we spoke with knew and understood their individual and shared responsibilities. Staff told us that recent changes in management, staffing and shift patterns had enabled and supported them to deliver good quality care.