30 July 2014
During a routine inspection
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, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 30 July 2014. The inspection was unannounced, which meant the provider and staff did not know we were coming.
There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
At our previous inspection in December 2013 the provider was not meeting the requirements of the law in relation to the safe management of medicines, staffing levels and staff training. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made.
The home provides accommodation and nursing for up to 66 people who have mental health needs. There are three units at the home; Jasmine, Poppy and Primrose units. There were 59 people living at the home when we visited.
All people we spoke with were complimentary about the service and its staff and were happy with the support they received. People told us there were enough staff to meet their day to day needs and described staff as kind and caring. There were some gaps in staff training, which the manager demonstrated they were addressing.
Staff were aware of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which help to support the rights of people who lack the capacity to make their own decisions or whose activities have been restricted in some way in order to keep them safe. The impact on people living at the home of recent changes in the definition and extent of DoLS had been considered. The manager had taken appropriate action in relation to people affected by these changes.
Staff demonstrated an awareness of what could constitute abuse and that matters of abuse should be reported in order to keep people safe. Staff were aware of the provider’s whistleblowing policy and said they would use it if they felt there were any issues they were concerned about within the home.
We found that the home did not have appropriate forms to record any instances of restraint which occurred, in order to safeguard people who had been restrained. The manager was made aware and said he would implement a suitable recording system.
People were involved in their care planning and received a thorough initial assessment so that staff could understand their needs. We saw staff delivering support to people in the way described in their care records and which met their needs and respected their privacy and dignity. The home gathered people’s views and fedback to people about what improvements they had implemented as a result of people’s suggestions.
People who were living at the home, staff and an external professional praised the improvements implemented by the home’s manager. People told us they liked the management team and found them approachable. This meant that people felt confident in raising issues with the home’s management team.
People’s health and well-being were supported by staff arranging appointments with external healthcare professionals when required, such as a G.Ps and mental health professionals.
We found improvements, since our last visit, in the way medicines were managed at the home. However, we saw that some improvements were still required. We saw that people did not always receive the prescribed doses of their prescribed medicines and there were inadequate instructions for nurses as to when ‘when required’ medicines should be given to people. This meant that people were not always protected from the risks associated with medicines.
We saw that one person needed specific foods to meet their cultural requirements in connection with their diet. We found that these foods were not always provided to this person. We also found that staff serving food were unaware of one person being diabetic and therefore needing a diabetic appropriate diet. We saw that staff offered people plentiful fluids throughout the day.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.