Archived: Slate House Residential Home

Updated 12 February 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 checked 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 27 October 2014 and was unannounced.

The inspection team consisted of an adult social care inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert involved in this inspection had expertise in care of older people and dementia care.

Before the inspection visit we looked at previous inspection reports and notifications we had received. Notifications are sent to the Care Quality Commission to inform us of events relating to the service. We also reviewed the Provider Information Return (PIR) which gave us information about the service, what it does well and the improvements planned for the future. We received feedback from one local authority commissioners and safeguarding team as well as the community pharmacist and one healthcare professional who works with the provider.

During the inspection we spoke with four people who use the service, three members of staff, three relatives, the registered manager and a visiting healthcare professional. We observed the lunchtime activity, observed people in the communal lounge and attended the shift handover between morning and afternoon staff. We reviewed four people’s care plans, three staff recruitment files, staff duty rotas and a selection of policies and procedures relating to the management of the service.

Updated 12 February 2015

This was an unannounced inspection which took place 27 October 2014.

At the last inspection of Slate House Residential Home in October 2013 we found no concerns.

Slate House Residential Home is registered to provide accommodation for up to 13 people. The home specialises in the care of older people, some of whom may be living with dementia. At the time of the inspection 9 people were living at Slate House Residential Home.

The home has a 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.

Although people and their relatives told us they felt safe and did not raise staffing levels as an issue in the day to day running of the home we found there were insufficient staff to ensure people’s safety. We looked at the provider’s duty rotas and found there were a number of shifts understaffed.

In their training and development policy the provider stated emergency first aid was a core module for all staff. We found that five out of eleven members of staff had either not completed the training or their training was out of date. There was a risk that people would not receive appropriate support in the event of a medical emergency.

Whilst medicines were stored and disposed of safely we saw that the care staff responsible for administering medication were also expected to manage a mealtime activity. There were seven people eating and minimal assistance was available from other care staff. There was a risk that the care worker would be distracted and a medication error could occur.

The provider had not reviewed the Statement of Purpose for Slate House since appointing the registered manager. Therefore we could not be assured current information was available for people and relatives.

Staff were knowledgeable about protecting people from harm and knew what they should do to report abuse or raise concerns if people were at risk of harm. The registered manager had a good understanding of the Mental Capacity Act 2005 (MCA). The MCA provides the legal framework for acting and making decisions on behalf of individuals who lack the mental capacity to make particular decisions for themselves. However, they were not aware of recent changes in practice following a Supreme Court ruling in regard to the Deprivation of Liberty Safeguards (DoLS). The DoLS provide legal protection for vulnerable people who are, or may become, deprived of their liberty. The registered manager said they would make contact straight away with the local authority DoLS team to seek advice.

People and their relatives were positive about the staff and the care provided. One relative said: “staff are excellent” and another commented on staff consistency and low staff turnover. We saw staff supporting people in a kind and caring manner. We found staff were attentive to people’s needs. Relatives told us staff understood the needs of the people they supported. One relative commented: “Whenever you go, the staff are so kind and genuinely care" and another referred to Slate House as: “home from home.”

Staff received induction training when they began work. Core training was provided however, we saw some staff had not been provided with this training. Staff received regular supervision from the registered manager. They told us they found the registered manager supportive and approachable. However, there was no evidence of the provider conducting annual staff appraisals to provide an opportunity to discuss their work and development.

The décor of the home was tired and worn. We found there was a ‘musty’ smell in the entrance hall and some carpets were stained and in need of replacement. The environment of the home was not designed to be ‘dementia friendly’ and there had been no specific adjustments made for people living with dementia.

People enjoyed their food and relatives told us it was: “absolutely fabulous.” We saw food was fresh, plentiful and served attractively. Special diets were catered for and staff were knowledgeable about people’s nutritional needs.

People had their health risks assessed, these included pressure ulcers, malnutrition and falls. Identified risks were managed with such things as pressure relieving equipment, special diets and mobility aids. However, risks were not always managed appropriately due to insufficient staffing levels at night and people had developed moisture damage. Where necessary health and social care professionals were contacted for advice and support. Professionals were positive about the way staff responded to people’s changing needs.

People, and where appropriate their relatives were involved in planning and making decisions about their care. Staff were provided with guidance to meet people’s individual needs and preferences. People were treated with dignity and respect.

There were systems in place to encourage people to give feedback on the service. Residents meetings were held and satisfaction questionnaires had recently been sent. Relatives said they could post comments in the ‘comment box’ and everyone we spoke to said they would have no hesitation in talking to the registered manager or any of the staff if they had concerns. No-one had cause to make a complaint since the last inspection.

Regular health and safety checks were carried out as well as some audits of the service. However quality assurance systems were not always used effectively to identify areas of the service which may need improvement and there were no records of how the provider monitors the service or the registered manager.

Although a programme of activities was available to people at Slate House we were told activities could not always take place as planned due to staffing levels. One person and several relatives commented on the lack of activities outside of the home and said they would like to see more outings provided. However links to the community were maintained with visits from the mobile library, a minister of religion, the local primary school and a visiting ‘pat dog’.

We found a number of breaches 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.