30 September and 1 October 2014
During an inspection looking at part of the service
As part of this inspection we spoke with five people and three visitors. We spoke with 24 staff. We also spoke with the provider, interim manager, four external training providers and an external social worker. We looked at 31 people's records. This included, care plans, risk assessments, medication administration records and records kept in people's rooms that were used to monitor their care. We also reviewed records relating to the management of the home that included 12 staff files, duty rota and training records.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we viewed.
Is the service safe?
During our inspections in April 2014 and July 2014 we identified risks to people who use the service. We asked the provider to make improvements. At this inspection we found there had been minimal improvements to impact on the quality of the services provided to ensure people's safety.
We found there was a risk that people's care and welfare needs were not fully identified or met by the staff team. This was because people's care plans did not detail how the person wanted their needs to be met. Risk assessments identified risks associated with personal and specific health and behavioural related issues. However there was limited recorded guidance for staff to minimise those risks.
The service provided was not safe because people were not protected against the risks associated with medicines. The provider did not have appropriate arrangements in place to manage people's medicines safely.
The provider had not taken sufficient steps to improve staff training, support and supervision needed for staff to meet the mental health needs of the people who were using the service. This meant people using the service were at risk of not receiving the care and support they needed, as not all staff had the required skills to meet their individual needs and keep them safe.
Is the service effective?
Since our last inspection in July 2014 improvements had been made to improve the level of recreational activities people were provided with. However, these were not person centred to individual needs with particular reference to people who live with dementia and people with mental health conditions.
Care plans had not been developed to ensure individual needs were met and risks minimised.
Is the service caring?
People we spoke with were mostly complimentary toward the staff and the care they received. We observed both positive and negative staff interactions with people who use the service.
There was insufficient information for staff to be fully informed how to manage behaviours that were specific to individuals' that may present a challenge to the service and place people and others at risk.
Staff did not engage with people in a meaningful way to ensure people using the service felt valued and respected. Staff did not have sufficient skills to know the most effective way to support individuals who presented behaviours that placed people and others at risk whilst respecting the individuals' dignity and human rights.
Is the service responsive?
There was insufficient detail in the care plans to promote an effective and responsive individualised service for people who live in the home.