An adult social care inspector carried out this inspection. The focus of the inspection wasto answer three of the five key questions; is the service safe, responsive and well led? This was a follow-up inspection which focussed on looking at the progress made since the previous inspection in April 2014. Therefore, not all aspects of the five key questions were inspected on this occasion.
As part of this inspection we spoke with the manager. We also reviewed records relating to the management of the home in connection with the issues we were following up from the previous inspection. These included care files, risk assessments, management monitoring and other records.
Below is a summary of what we found.
Is the service safe?
We found that improvements had been made to training and guidance in order to increase staff awareness and understanding of safeguarding and restraint. All staff had attended safeguarding training and safeguarding scenarios had been discussed with staff in a recent team meeting. The home's safeguarding and restraint policies had also been updated. Staff now had appropriate written guidelines in place to support them to understand restraint in order to reduce the risk of inappropriate use. The manager demonstrated a clearer understanding of the reporting process, the role of the local authority safeguarding team and the circumstances when the home may undertake investigations.
The manager also demonstrated an improved understanding of the "Deprivation of Liberty Safeguards" (DoLS). Appropriate steps had been taken to address this by identifying people considered to need a DoLS application to the local authority. In one situation the risk that a person might be deprived of their liberty was addressed and suitable steps were put in place to avoid this.
We found that additional systems had been established to increase safeguards in regards to the use of bed-rails. A new risk assessment had been introduced ahead of their use. Additional guidelines and training had been provided to staff and daily and weekly checks of their function and fitment were now documented. Appropriate best interests discussions had taken place regarding the use of bed-rails in the case of the one person with whom they were in use.
We found that improvements had been made to the recruitment process and its recording. A complete record of applicant's employment history was now sought and the discussion of any gaps in employment was recorded. Applicants were asked to complete a health questionnaire. The manager had also sought information in the case of existing staff where gaps were identified at the previous inspection. These steps reduced the risk of people being supported by someone unsuitable to care for vulnerable people.
Improvements had been made in management monitoring systems for such things as falls, accidents and incidents. However, some of these systems were not yet used to best effect.
Is the service responsive?
We found that improvements had been made to records, systems and staff training with regard to consent and best interests decision-making. It was now clearer that people had consented to their care. Where people were unable to give consent, decisions made in their best interests were now better documented. Evidence was now available to confirm that the person providing consent on behalf of someone lacking capacity was legally able to do so.
People's capacity to consent to their care was now assessed as part of the preadmission process, where there was any doubt of this. The preadmission assessment format now addressed this. The home applied the assumption of capacity rule appropriately. We saw that where people had capacity, they were consulted about their care and provided their own consent.
We saw that people's care plans and other documents recorded their needs and were reviewed regularly to identify where these had changed. Care notes showed that people's consent was sought on an ongoing basis, although how this was done was not noted. One person had been offered opportunities to access the community with staff support to address an identified desire to do this.
The home had sought the views of the people supported through surveys and, more recently through residents meetings. Opportunities for people to be consulted and involved in decision making within the home had been improved. The minutes showed that people had been offered choices around such things as activities and menus.
Is the service well-led?
The manager had improved the range of audit and monitoring systems used to maintain an effective overview of the home's operation. Action had been taken to address issues where these were identified.
The manager had responded positively and made changes to policies, procedures, records and systems to address the issues identified in the previous inspection. Additional training had been arranged where shortfalls had been identified in staff knowledge and relevant discussions had taken place.
The manager had updated her knowledge about safeguarding and the Mental Capacity Act 2015 since the previous inspection in order to ensure that the home complied with appropriate practice and legislation.
Additional systems had been established to improve the ongoing monitoring of the home's day-to-day operation as well as safety issues such as falls and accidents. However, some of these monitoring systems were not yet used as effectively as they could be.
Staff were monitored through supervision, appraisal and regular team meetings. These systems meant that their performance, knowledge and development were monitored on an ongoing basis to maintain their skills.