The inspection was carried out by two inspectors. 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 safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, speaking with visitors and staff, and from looking at records. If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We saw that some people had behaviours that could be challenging to themselves and other people but plans were not in place to help staff analyse behaviours in order to minimise incidents from occurring. Some incidents had resulted in verbal and physical abuse between people who used the service. These had not always been discussed with the local safeguarding team and the Care Quality Commission had not been informed. It is important that we are informed of these incidents so we can monitor how they are managed.
The manager was aware of The Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), although no applications for people who used the service had needed to be submitted. Training records showed that nine out of thirteen staff had completed MCA and DoLS training, although we found there were some staff who needed to refresh this.
Staff had received training in how to manage safeguarding concerns in order to protect vulnerable people from the risk of abuse or harm.
Risk assessments were completed and steps had been taken to minimise risk, although we found these could be more thorough.
We observed people were treated with dignity and respect. People told us they felt safe in the service.
The service was clean and tidy and there was a maintenance and redecoration programme in place. There was a coded entrance and exit and all fire doors were alarmed.
The manager set the staff rotas and they took into consideration people's care needs when deciding on the numbers of staff on duty and the skills they required to meet people's needs. There were additional staff at tea time to ensure people's needs were met and the manager was recruiting further staff to support in the evenings and at weekends.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to protecting people from abuse.
Is the service effective?
People told us that staff asked for their consent to carry out day to day tasks with them. When people had been assessed as lacking capacity to make their own decisions, some best interest meetings had been held to discuss the decision required.
People's health and care needs were assessed and we saw that care plans contained people's preferences for how care was to be provided.
Visitors told us they were able to see their relatives in private and visiting times were flexible. They also said they were kept informed of incidents that affected their relatives.
People's nutritional needs were met. We saw menus contained a variety of food and the cook prepared special meals to suit preferences and needs such as vegetarian and pureed food.
Specific aids and equipment helped staff meet people's moving and handling needs.
There were memory boxes outside each person's bedroom door and staff had started to collect photographs of people at various stages of their life. This helped people with dementia to recognise which bedroom was theirs. There were also picture signs on doors of toilets and bathrooms, and bedrooms doors were painted in block colours. The manager was aware of research regarding how to make the environment friendly for people with dementia.
Is the service caring?
People were supported by kind and attentive staff. We observed staff speak to people in a friendly and professional way. We saw that staff gave people time to respond to questions and encouraged them to make decisions for themselves.
People who used the service and their relatives were asked for their views in surveys. We saw the returned surveys had positive comments about the care received by people who used the service.
Is the service responsive?
People had access to a range of health and social care professionals for support and treatment. Records indicated people received treatment in a timely way. This was confirmed in discussions with people and their relatives.
The service had policies and procedures in place for the management of complaints. People knew how to make a complaint if they had concerns or were unhappy about something.
The service had changed things as a result of feedback from surveys and audits. These included an update to the menus and the purchase of small pets such as a hamster, two budgerigars and tropical fish.
Is the service well-led?
The service had a quality assurance system which included checks to make sure the service was safe and meeting people's needs. It also included surveys and meetings to ensure people were able to express their views. However, results were not always analysed and there were not always action plans to address issues.
We found that learning from some incidents had not taken place, which meant that appropriate changes had not been implemented. Staff had monitored and recorded incidents between people who used the service, however, these had not been audited and analysed. This meant the manager and staff did not have information to hand that would enable changes in staff approach or practice to help minimise the behaviours.
We had not been notified of some incidents that had occurred between specific people who used the service. This meant we were not able to monitor how these were managed.
Staff were clear about their roles and responsibilities and had a good understanding of the ethos of the service. Staff had policies and procedures to guide their practice and received training, supervision and support from management.
The manager and provider made themselves available during the day and there was an on call system for evenings and weekends. This ensured staff felt supported and they knew who to contact for advice.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.
What people who used the service and those that matter to them said about the care and support they received: -
Comments included, 'I can get up and go to bed when I want to', 'I think I am looked after very well' and 'The staff are caring, it's a lovely atmosphere and it always smells nice.'
People said, 'I love it here; they really look after me', 'They get the doctor when I'm poorly. I'm arthritic and they keep checking my hands' and 'I was bad one night and they came and held my hand.'
Comments about the meals included, 'The food is really good; I am cheese-mad so they bring me cheese and biscuits', 'The food is perfect. I'm a vegetarian and they see to me', 'The food is very nice' and 'I can't grumble about the food.'
People were complimentary about the staff team. Comments included, 'The staff are very caring ' brilliant in fact', 'They are very good to us', 'Everyone is made to feel welcome', 'The girls are very nice', 'The staff are a good crowd', 'It's a very pleasant place and the carers are very nice' and 'They do cope with people very well.'
Other comments included, 'I have no complaints', 'Yes, I do feel able to complain; if anything was wrong I would tell the staff', 'There have been improvements; I would like them to have more one to one support' and 'If there were any doubts about care I would complain, definitely. The manager would sort it out; she is always milling about.'