We carried out a review of the data available to us about Craigielea Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Craigielea Nursing Home, you can give feedback on this service.
Craigielea Nursing Home is a care home that provides accommodation, nursing and personal care for up to 60 people, some of whom are living with a dementia. At the time of the inspection there were 56 people living in the home.
People's experience of using this service and what we found
The premises were safe and a range of risks were well mitigated. The registered manager had introduced additional checks to ensure the premises were free from clutter, clean and appropriate doors were kept locked.
People felt safe and well supported by staff. Relatives raised no safety concerns and felt staff did a good job in reducing the risks people faced. External professionals shared similar feedback.
There were sufficient staff on duty, and planned in the rota, to ensure people received safe levels of care and the environment was clean and safe.
People’s care plans were up to date. Staff updated records electronically via handsets. At times information was added retrospectively due to the number of handsets available. The registered manager and provider assured us they would improve the contemporaneous nature of records.
Systems and processes for identifying patterns and trends were in place. Regular reviews of falls, safeguarding incidents and other incidents were analysed to try and reduce the risk of them repeating.
Medicines administration was safe. Records were clear and there were examples of good practice, for instance the recording of ‘when required’ medicines and topical medicines (creams). Regular auditing was in place and identified individual errors and areas for improvement, which were acted on. Where there was scope for improved working with the pharmacy, the provider pursued this.
People were kept safe from the risk of abuse. Relevant policies were up to date and information on how to report any concerns was readily available. When incidents occurred the provider acted promptly. The recording of some investigations could have been clearer and more open to scrutiny. The provider responded positively to this feedback and assured us they would review how investigations were documented and reported on.
Staff were recruited safely. Staff felt well supported and able to speak up if they had concerns.
The registered manager had made some positive changes and had more planned. The atmosphere during inspection was upbeat, with a school visit taking place and people relieved that staff were no longer required to wear masks at all times.
There were a range of champions in place for specific areas of practice, such as infection prevention and control, and end of life care.
The registered manager had surveyed people, relatives and visiting professionals regarding the standards of care.
External professionals felt communication from the registered manager was effective.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The registered manager demonstrated a good understanding of the service and people who used it.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 13 April 2022).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Craigielea Nursing Home is a care home that provides accommodation, nursing and personal care for up to 60 people, some of whom are living with a dementia. At the time of the inspection there were 54 people living in the home.
People’s experience of using this service and what we found
The premises were not always safe for people living at the home. Staff were not always following safe infection, prevention and control processes and environmental risks people may face had not always been fully identified, assessed or mitigated. During both days of inspection staff failed to safely lock away chemicals, remove items from fire escapes and follow processes to reduce the risk of cross infection.
Following our first day of inspection the registered manager took action to address the issues, but we found on our second visit that staff were still not following safe processes. For example, ensuring cupboards storing chemicals were kept locked. The registered manager and provider were working with staff to make sure all health and safety risks are fully identified and mitigated to keep people safe.
The provider had a robust quality and assurance system in place to monitor the safety and quality of care provided. We found the checks in place for health and safety and risk management were effective, and the issues identified during the inspection process were the result of staff not following the provider’s policies and processes.
Medicines were managed safely at the home. Staff had received regular training and had the skills to administer medicines safely. Clinical staff were supported with supervisions and training by the registered manager, who was a registered nurse.
People were happy and content living at the home. Relatives were positive about the care provided by the staff and registered manager. One relative said, "The [staff] are lovely, they’re a great bunch and I can’t fault them." People and relatives said they felt people were safe living at the home.
Staffing levels were safe and regularly reviewed to meet the needs of people. Staff were recruited safely by the provider and all pre-employment checks were in place. Staff said there were enough staff at all times.
The registered manager and provider had safely managed all risk associated with COVID-19 during the pandemic . Visitors were required to provide a negative lateral flow test before entering the service and professional visitors had to evidence they had received both doses of their COVID-19 vaccine. Staff wore appropriate personal protective equipment (PPE) and there was an adequate supply of PPE throughout the home. Relatives told us that people had been kept safe and happy during the pandemic. Their comments included, “During the pandemic, I felt [Name} was safer than me out here” and, “They’ve kept [Name]really safe during it all.”
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 29 June 2018).
Why we inspected
We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about visiting arrangements during an outbreak at the home. A decision was made for us to inspect and examine those risks.
We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We inspected and found there was a concern with environmental risks within the home, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.
You can see what action we have asked the provider to take at the end of this full report.
The provider and registered manager have taken action to mitigate the concerns identified during the inspection and were working to improve the service. The management team at the service had worked positively in partnership with the CQC during the inspection process and were addressing the concerns with the staff team.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Craigielea Nursing Home on our website at www.cqc.org.uk
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified a breach in relation to safe care and treatment due to the concerns found around the risks associated with the environment at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Craigielea Nursing Home provides nursing and personal care for up to 60 older people. 54 people were using the service at the time of the inspection. Some were living with dementia.
People’s experience of using this service and what we found
Risks were well managed. Moving and handling equipment was checked to ensure it was safe. Risk assessments were regularly reviewed and up to date.
Appropriate measures were in place to reduce the risk of infection. Personal protective equipment (PPE) was appropriately stored, used and disposed of. Staff had undertaken additional training in infection prevention and control and regular audits were carried out.
Medicines were safely stored and administered. Records were up to date and regularly audited.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 29 June 2018).
Why we inspected
We undertook this targeted inspection to check on specific concerns we had received about moving and handling practices, medicines management and due to an outbreak of COVID-19 at the service. The overall rating for the service has not changed following this targeted inspection and remains good.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Following the last inspection, we met with the provider to ask them to provide an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well led to at least a good rating. At this inspection we found the provider had made improvements and was no longer in breach of regulations.
Craigielea Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The care home accommodates 60 people across four separate units, each of which have separate adapted facilities. Two units specialised in providing care to people living with dementia. One, having been recently redesigned to accommodate people living with dementia who required nursing care. No people were residing on this unit at the time of the inspection. Another unit provided general nursing care. At the time of the inspection 41 people were being supporting in the home, 18 of which required nursing care.
Since the last inspection the provider had employed a new manager who is now registered with the Care Quality Commission. 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.
The provider had policies and procedures in place to keep people safe. The provider had effective systems in place to manage medicines. Risks to people and the environment had been assessed and control measures were in place to reduce risk. Staffing levels were appropriate to meet the needs of the people using the service. The provider had system and process in place to report and manage safeguarding issues. Staff understood safeguarding and knew how to report their concerns. Accidents and incidents were recorded and analysed for trends and patterns. The recruitment process used by the provider was robust. Health and safety checks were completed on a regular basis. Fire safety procedures were in place. The environment was clean and tidy. Infection control procedures were in place. Staff had access to personal protective equipment (PPE) when needed.
Care and support was provided using best practice, such as following health and safety guidance. Training plans were in place, along with supervision and appraisal planners. Staff felt supported in their roles. People and relatives felt staff were well trained and knew how to support them well. People were supported with their nutritional needs where necessary. Staff contacted health care professionals when appropriate. Staff understood the Mental Capacity Act and gained consent prior to any care being delivered. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.
People and relatives felt the staff were kind and caring. Staff showed respect and promoted dignity when supporting people with care. People were encouraged to be independent. Staff had positive relationships with people and their relatives. Staff spoke with fondness about the people they supported. When changes in support were needed, people and/or their relatives were involved. The service had information available to people and relatives regarding advocacy. People had communication plans in place to ensure staff could positively engage with those they supported.
The environment had been developed to be more dementia friendly with areas of interest for people, such as garden areas. Rooms were personalised with ornaments and pictures. Communal areas were comfortable, with a range of seating for people to meet.
Care plans were in place setting out individual needs, likes, dislikes and preferences. People were involved in care planning where ever possible. Care plans were reviewed and updated when necessary. The provider had a policy in place to manage complaints. Staff were trained to support people with end of life care. Several compliment cards demonstrated how staff had cared for people in a compassionate manner.
People, relatives and staff felt the registered manager was open and approachable. The provider had a quality assurance process in place to monitor the quality of the service and to drive improvement. Regular meetings were held for people and their relatives. Surveys were completed to gain the views and opinions of people, relatives, other stake holders and staff. The provider used the results to improve the service. The registered manager submitted notifications to CQC in line with regulation.
In December 2016 we carried out an inspection of this home and found three breaches of regulation. These related to equipment not being safe for use or used in a safe way, infection control management and unsafe management of medicines. The provider had failed to ensure there were suitably qualified, competent and skilled staff deployed to provide care, support and treatment. We found the provider had not ensured systems and processes were used effectively to assess, monitor and improve the safety of the services provided.
This inspection was also prompted in part following concerns raised by the local authority commissioners regarding care and support, record keeping, lack of consistent nursing staff and ineffective leadership within the service.
Craigielea Nursing Home provides accommodation, nursing and personal care for up to 64 people including those living with dementia. The service was supporting 46 people at the time of this inspection.
The service does not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
The service had a manager who commenced employment in March 2017 and was still in their probationary period. The provider told us the manager intended to submit an application for registration with the Commission. Following the inspection the provider informed us that the manager had left the service. The operations manager was supporting the service until a new manager was employed.
On the first two days of the inspection the manager was on planned annual leave, we were supported by two interim managers from the provider’s neighbouring locations and the operations manager. The operations manager was also available on the second and third day of the inspection. The manager had returned to work on the third day of the inspection. Following our inspection the operations manager sent us information to confirm that the manager had left the service. The operations manager told us they were overseeing the service until a new manager was recruited.
At this inspection we found that there were breaches of four of the Fundamental Standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, safeguarding, staffing recruitment and the overall oversight of the home.
Medicines were not always managed safely. We found gaps in the recording on the medicine administration records (MAR). Where people were prescribed ‘as and when medicines’ protocols for such administration were not readily available for staff when administering medicines. The provider did not have topical MARs in place for staff guidance and support when administering topical medicines. Topical medicines are creams or ointments applied to the skin.
One treatment room which contained medical dressings and other equipment used to care for people requiring nursing care was unlocked. We found sharps (such as needles) stored in cupboards which were also unlocked.
The provider had not identified some incidents as potential safeguarding concerns and had not acted appropriately to ensure people were safe.
Risks to people had been assessed, however some assessments contained conflicting information.
The provider had failed to ensure staff were suitably competent and skilled to provide care support and treatment. The provider had a reliance on agency staff to cover shortfalls in nursing positions. The provider made requests for consistent agency staff when contacting the agency. Staff had not received regular supervision or appraisal. Nursing staff had not received any form of clinical supervision. Following our inspection the operations manager sent us information to confirm that a clinical lead had commenced employment in the home to provide support to nursing staff.
Training was out of date for some staff in certain subjects. We found gaps in the training for specific subjects such as Percutaneous Endoscopic Gastrostomy care (PEG) and diabetes. PEG is a tube which is passed into the stomach to provide a means of feeding when oral intake is not adequate. Training had been planned for nursing staff to cover these areas as part of the service’s action plan. Following our inspection the operations manager sent us information to confirm that training in PEG had been completed by all nurses.
Although people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way. We found the provider did not have a robust system of monitoring the timeliness of people’s applications for renewal of Deprivation of Liberty safeguards (DoLS).
People’s care records were not always personalised, or contained detail for staff to follow to ensure safe support and guidance. People’s preferences regarding activities, hobbies and interests were not always captured. Records in relation to people’s health and nutritional needs were not always completed fully and there was no evidence of oversight regarding monitoring of these records.
We have made a recommendation about the provider's approach to care records.
The provider had a complaints policy and procedure in place. We found the provider had not always notified complainants of the outcome of their complaint.
We made a recommendation about the management of complaints.
Statutory notifications were not submitted to CQC in a timely manner. People’s personal records were not held in line with the Data Protection Act.
Quality assurance processes were not effective in assessing, monitoring and improving the service. We found the quality assurance process had not highlighted some of the concerns raised at this inspection. The records relating to provider visits did not demonstrate a consistent approach.
You can see what action we told the provider to take at the back of the full version of the report.
People and relatives who used the service were complimentary about the standard of care at Craigielea Nursing Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves whenever possible.
The provider ensured appropriate health and safety checks were completed. We found up to date certificates to reflect fire inspections, gas safety checks, and electrical wiring test had been completed.
A business continuity plan was in place to ensure staff had information and guidance in case of an emergency. People had personal emergency evacuation plans in place that were available to staff.
At the time of the inspection the provider was working with the local authority and had developed a comprehensive action plan to drive improvement in the home.
The Craigielea Nursing Home provides accommodation, nursing and personal care for up to 64 people, including people living with dementia. There were 38 people living there on the day of our inspection.
The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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.
People told us they felt safe. Staff took steps to safeguard vulnerable adults and were trained and guided on safe care practices.
Those areas of the home subject to recent refurbishment were pleasantly decorated, with well-furnished lounges and seating areas. A new ‘café’ area had seating less suitable for people with physical support needs. Most areas of the building were safe and well maintained. There was excess storage in some bathrooms. The property was adapted from an older building with a later purpose built extension. Adaptations had been made and additional signage provided to improve safety and highlight potential hazards. Other risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring. On the whole, the home was clean.
We observed staff acted in a courteous, professional and safe manner when supporting people. We heard mixed views about the adequacy of staffing levels. These were subject to ongoing review and shortfalls in nursing were covered by the use of agency staff. The provider had a robust system to ensure new staff were subject to thorough recruitment checks.
Medicines, including topical medicines (creams applied to the skin) were, in most cases, safely managed, although the stock rotation and disposal of sharps required attention.
As Craigielea Nursing Home is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. People’s mental capacity was considered through relevant areas of care, such as with medicines and distressed behaviour. Where necessary, DoLS had been applied for. Staff routinely obtained people’s consent before providing care.
Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were well supported by their managers and other senior staff. Staff performance was assessed annually and objectives set for the year ahead.
People’s nutritional and hydration (eating and drinking) status was assessed and plans of care put in place where support was needed. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to access healthcare services.
Staff displayed an attentive, caring and supportive attitude. We observed staff interacted positively with people. We saw that staff treated people with respect and explained clearly to us how people’s privacy, dignity and confidentiality were maintained.
A limited range of activities were offered within the home on a group and one to one basis. An activity worker post was vacant. Staff understood the needs of people and we saw care plans and associated documentation were clear and person centred.
Processes were in place to manage and respond to complaints and concerns. People were aware of how to make a complaint should they need to.
People using the service and staff spoke well of the registered manager and nursing staff felt she provided good clinical leadership. Communication was evident between staff working different shifts. Systems to assess and monitor the quality of the service included seeking feedback from people receiving care so their views could be incorporated into ongoing improvements.
We found breaches of the regulations relating to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.
The inspection took place on 16, 17 and 28 September and 5 October 2015 and was unannounced. This means the provider did not know we were coming. We last inspected Craigielea Nursing Home in March 2015. At that inspection we found the service was not meeting the legal requirements in force at that time and issued two warning notices relating to staff training and the management of quality in the service.
Craigielea Nursing Home provides personal care for older people for up to 64 people, including people living with dementia. Nursing care is also provided at the home. At the time of our inspection there were 39 people living at the home.
The service had a registered manager who had been in post for fifteen years. 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.
People said they felt safe at Craigielea. Staff were trained in and understood the importance of their duty of care to safeguard people against the risk of abuse.
People expressed mixed views about staffing levels and there was no formal mechanism to help calculate staffing levels based on people’s needs. New staff were suitably checked and vetted before they were employed.
The home was undergoing extensive refurbishment, and those areas where work was completed were decorated and equipped to a high standard. Some areas were clean, others areas, along with pieces of medical equipment, were not. Safety checks were conducted to ensure people received care in a safe environment.
On the whole, medicines were managed safely to promote people’s health and well-being. One person did not receive their medicines in line with their care plan and this was addressed during the inspection.
Staff were supported in their roles to meet people’s needs. Extensive training had been carried out since we last inspected and further training was being undertaken.
People’s nutritional needs and risks were monitored and people were supported with eating and drinking where necessary. People were supported to meet their health needs and access health care professionals, including specialist support.
People were consulted about and were able to direct their care and support. Formal processes were followed to uphold the rights of those people unable to make important decisions about their care, or who needed to be deprived of their liberty to receive the care they required.
Staff knew people well and the ways they preferred their care to be given. People and their relatives told us the staff were kind, caring and respectful in their approach. On the whole our observations confirmed this, however the delay in responding to a person’s requests for support did not promote their dignity. Response times to call alarms were varied, but at times were excessively delayed.
A range of methods were used that enabled people and their families to express their views about their care and the service they received. Concerns or complaints were clearly documented, investigated and the outcome reported to the individual concerned. Where necessary practice was changed or other measures taken in response to the concern raised.
Staff assessed people’s needs and risks before they moved in and periodically thereafter. Staff ensured care plans were in place and regularly reviewed. A variety of activities were made available to encourage stimulation and help people meet their social needs.
The management arrangements ensured clear lines of accountability. Systems to monitor and develop the quality of the service had improved since we last inspected, but required further refinement to ensure standards of hygiene and safety were more consistently assured. Quality monitoring arrangements included seeking and acting on feedback from the people using the service and their relatives.
We made a recommendation for the provider to assess staffing levels in relation to people’s levels of need.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the cleanliness and security of the premises and equipment and to the deployment of staff. You can see what action we told the provider to take at the back of the full version of this report.
This inspection took place over three days, 17, 18 and 24 March 2015. The first day of the inspection was unannounced. We last inspected Craigielea Nursing Home in October 2014. At that inspection we found the service was meeting the regulations we inspected.
Craigielea Nursing Home provides accommodation, nursing and personal care for up to 64 older people, including people living with dementia. At the time of the inspection there were 48 people living at the service.
The service had a registered manager who had been in post since November 1999. 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.
Out of 26 Medicines administration records viewed a number of recording errors were identified in four records, however we observed people’s medicines were administered and stored appropriately.
The provider’s policies and procedures were out of date. This meant current information and guidance was unavailable for staff to refer to and what was expected of them when providing care for people and ensuring their safety and wellbeing.
Staff recruitment practices at the home did not always ensure that appropriate recruitment checks were carried out to determine the suitability of individuals to work with vulnerable adults, placing service users at risk of harm. Satisfactory reference checks and confirmation of applicant’s identity had not been conducted and information on application for employment forms were incomplete.
The service did not always protect people against the risk of unclean, insecure and properly maintained premises and equipment. Infection control was not appropriately managed and this presented a risk of infection to service users, staff and visitors.
We viewed safeguarding adults and whistleblowing policies at the service. We found they were not current and were last reviewed and updated in January 2013. Some staff had not received, or were overdue safeguarding adults instruction. Not all staff we spoke with were able to tell us what procedures or who they would contact outside of their organisation if they needed to report a safeguarding incident externally. Staff were able to tell us what constituted abuse and the procedures they would follow internally if they witnessed abuse. Each member of staff we spoke with told us they were confident management would deal with any reports they made effectively.
People using the service told us they were well cared for and felt safe with the staff who provided their care and support. One person told us, “Oh yes (I feel safe); this is ideal for me… I am much safer here than at home.” Another person commented, “Yes (I feel safe); the people we have got (staff) are exceptional.”
The service was not effective. We found there were gaps in the provision of training for all staff which meant people were at risk of unsafe working practice from staff who did not have the skills and knowledge to consistently meet their need. Almost 50% of the staff who provide care for people living with dementia at the home had not received training in how to provide good dementia care.
We found that regular supervision sessions were being conducted, though some staff were overdue an annual appraisal. All new staff received appropriate induction training and were supported in their professional development. However, no specialist care related training was undertaken by staff regarding specific conditions some of the people they cared for may have.
People were not always supported to make sure they had enough to eat and drink. People and their relatives were complimentary about the variety and quality of their meals and told us they enjoyed the food prepared at the home and had a choice about what they ate.
We found that there was limited understanding of Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) which meant the code of practice was not applied consistently or appropriately so some people were at risk of their human rights to make particular decisions was being denied to them.
People were supported to keep up to date with regular healthcare appointments and we were told where referrals were needed for external professionals to support people, this was done in a timely manner.
The service was not consistently caring. We saw occasions where people had been left unsupervised without interaction and contact with staff. A specific observation confirmed that some people did not receive supervision or interaction with staff.
Meetings for people using the home and their relatives were held. Advocacy information was accessible to people and their relatives. However, no surveys or questionnaires, in order to seek and act on feedback from people and their relatives in order to evaluate and improve the service were currently undertaken by the service.
We observed staff acting in a professional and friendly manner, treating people with dignity and respect. However, occasionally some staff appeared task driven and orientated, and as such, appeared to ignore people and did not take the time to listen to them. People were sat in the dining areas for long periods before they were served their meals.
We observed some good caring relationships between staff and people living in the home. Staff were seen checking on a regular basis if people needed support. Staff were seen acting in a professional and friendly manner, treating people with dignity and respect.
Care plans were not regularly reviewed and evaluated. They did not contain up to date information on people’s needs and risks associated to their care.
There was a lack of planned activities, stimulation and involvement of people in meaningful activities. The service did not currently employ an activities coordinator. This meant people who were nursed in bed, or preferred to remain in their bedrooms were at risk of social isolation.
An effective complaints process was in place. People and their relatives told us they felt able to raise any issues or concerns. Records confirmed complaints made were investigated and appropriate action was taken.
The service had a registered manager. We received positive feedback from people, their relatives and staff about the registered manager and how the service was managed and run. Staff told us they enjoyed a good relationship with the registered manager. One care assistant told us, “Any issues I have’ I will go and see the manager.” Another care assistant said, “I feel happy about going to see Deborah (registered manager) if I need to.” One relative told us, “It’s a nice home, it has a lovely feel to it,” Another relative told us a meeting had been arranged recently by the registered manager for relatives to explain the on-going building work and explaining the anticipated time for it to be completed.
Quality monitoring systems currently being used did not always ensure the service was operating safely and effectively.
Current quality assurance audits undertaken were irregular and ineffective. Monthly medicines audits conducted repeatedly identified discrepancies and shortfalls in the service’s management of medicines, yet no remedial action was taken. Monthly care plan audits conducted were not regularly undertaken and were ineffective.
The provider was not considering best practice in relation to meeting the needs of people using the service.
During our inspection we identified a breach in seven regulations. You can see what action we told the provider to take at the back of the full version of this report.
During the inspection five key questions were answered; is the service safe, effective, caring, responsive and well-led?
Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
All the people we spoke with told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, 'The staff are first class. I definitely feel safe here.' Another person told us, 'I feel I can approach the staff when I want about anything. I know how to make a complaint or raise a concern.' All the relatives we spoke to told us they felt their relatives were safe at the home, one of them told us, 'It's a good service. I have no concerns of abuse; I feel my relative is safe.'
We spoke with staff about Deprivation of Liberty Safeguards (DoLS). The registered manager told us that there had been one application in the last year and showed us the policy and procedures they followed. They told us that some staff had received relevant training and had access to the policy and procedures. Those staff told us that they had received this training.
Is the service effective?
One person commented, 'I was losing weight at home before I came here. I have put on a stone and the staff have really encouraged me.' A relative told us, 'We have seen real progress here, the staff are very good.'
People explained how their care and welfare needs were met. All people told us that they had support with health appointments and felt that the service was flexible. One person told us, 'It's smashing here. If you want anything the staff will do it for you.' All the people we spoke with told us that they were always asked by staff if they needed help or assistance by staff. The staff told us that they always asked people if they were happy and required assistance before providing help.
All the staff told us they felt supported in their work. They told us they received a full training programme. One person told us, 'I have received a full induction when I started. I definitely feel well supported.' Another staff member told us, 'I feel well supported, and there is so much training on offer. I feel supported by the manager; I can talk to them at any time.'
Is the service caring?
We saw that staff communicated well with people and were able to explain things in a way that could be easily understood. We saw that they did not rush people in the home and we saw that the interactions were caring. All the relatives we spoke with said they felt the care was very good. One relative told us, 'It's a brilliant service; the staff are really good. They always manage to listen. I am very happy with the care.'
We saw that people were treated with respect and dignity by the staff. We saw that people were given choices in their care and all the relatives we spoke to told us they were very happy with the care. All the people we spoke with told us that they were happy with the care and support they received.
Is the service responsive?
All the people we spoke to told us that staff would respond to any of their requests for support. One person told us, 'They give people opportunities to stay independent. But if you need help the staff will help.' Another told us, 'It's a good service. If I am not well they will call a doctor.'
All the relatives told us that they were very happy with the service. One told us, 'We are very much involved in the care of our relative. When there are any changes the staff always let us know.'
We saw that staff responded to people's requests for help in a timely way.
Some of the people we spoke with told us they were involved in decisions about their care. They told us that the staff were flexible and responded to their requests promptly. One person told us, 'I can get up in the morning when I want. I just need to ask for help.'
We saw that there was a complaints policy at the home. People told us they found the manager very approachable and would not hesitate to raise any issues or complaint.
People's care needs had been reviewed at least every six months. We saw that when people's requirements had changed the provider had responded and reviewed their care needs so that they could meet their changed support and care needs.
People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.
Is the service well-led?
We spoke with the registered manager. They showed us that there was an effective system to regularly assess the quality of service that people received. We found that the views and opinions of people, relatives and staff had been regularly recorded and responded to. The manager showed us that they had just recruited a new activities co-ordinator in response to the views and opinions they had received.
We saw the home had systems in place that made sure managers and staff learnt from any accidents, complaints, whistleblowing reports or investigations. This helped reduce the risks to people and helped the service to continually improve.
Staff told us they understood their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received a good quality care service at all times.