The inspection visit was carried out on 04 June 2015 and was unannounced. The previous inspection was carried out in July 2013, and there were no concerns.
The home provides accommodation, and personal care for up to 25 older people living with dementia. There were 23 people receiving care and support on the day of the inspection. Accommodation is provided over two floors with a passenger lift between floors.
The service is run by a registered manager, who was present on the day of the inspection visit. 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 and associated Regulations about how the service is run.
The service was generally clean in all areas. Bedrooms were vacuumed daily and were dusted on alternate days. Communal areas and toilets were cleaned daily, and bathrooms and shower rooms between use. The service allocated one member of domestic staff to clean a large building every morning. This was not sufficient to keep up with the demands of deep cleaning for carpets needed for bedrooms and communal rooms on a regular basis, or to carry out extra cleaning tasks such as moving beds out and cleaning underneath them, and cleaning skirting boards.
The registered manager was familiar with the ‘Code of Practice for health and adult social care on the prevention and control of infections and related guidance’ which sets out the requirements for regulated services to meet the regulation for cleanliness and infection control. This was applied as far as possible, but cleaning was inadequate with insufficient staff to carry it out. Three waste bins were unsatisfactory. One was for disposal of paper towels in the staff toilet, but the pedal was broken and so staff had to touch the lid for disposing of paper towels. Waste bins outside the kitchen and in the ground floor sluice room were visibly old and had damaged paintwork on the metal, meaning that they could not be cleaned thoroughly.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The deputy manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager was fully informed about how and when to make applications for DoLS authorisations, and had applied for some previously. There was currently no one in the service who had a DoLS authorisation.
Staff had been trained in safeguarding adults, and discussions with them confirmed that they understood the different types of abuse, and knew the action to take in the event of any suspicion of abuse. Staff were aware of the service’s whistle-blowing policy, and were confident they could raise any concerns with the registered manager, or with outside agencies if they needed to do so.
The service had systems in place for on-going monitoring of the environment and facilities. This included maintenance checks, and health and safety checks. There were comprehensive risk assessments in place for each area of the premises. These showed how to minimise the assessed risks. The risk assessments were reviewed by the registered manager as part of regular monitoring programmes. There were individual risk assessments for each person living at the service. These included assessments for the risk of falls, developing pressure sores, using stairs, and risks associated with poor mobility. The risk assessments were written in relation to each person’s needs. Actions were identified and put in place to lessen the risks. Each person had a personal emergency evacuation plan (‘PEEP’) kept in a folder with other information in case an emergency evacuation should be needed.
The registered manager and staff were visible throughout the service during the day. There were sufficient care staff to attend to people’s needs and requests without rushing them. People and their relatives spoke highly of the staff with comments such as “All the staff do an excellent job”. The service had robust recruitment procedures in place to check that staff were suitable for their job roles.
The company provided new staff with a detailed induction which included all essential training. The registered manager and deputy discussed aspects of their training with staff to ensure they fully understood and knew how to apply it. Staff were kept up to date with refresher courses for essential training, with subjects such as fire safety, food hygiene, health and safety and moving and handling. Staff were encouraged to carry out formal training qualifications in health and social care, and all the care staff had completed this training to levels 2 or 3 or were studying for these. Other training was provided which was relevant to staff’s job roles. All staff were trained in dementia care, and some had carried out advanced training. Their understanding of this training was evident in how staff supported people with their care. Staff had individual supervision every two months, and said that they could speak to the registered manager at any time if they required additional support or advice. Staff meetings were carried out nearly every month, and staff said they could ask anything at these meetings.
Medicines management was overseen by the registered manager and deputy manager, who carried out arrangements for repeat prescriptions and receipt of medicines into the home. Only senior staff who had completed training and been assessed for their competency were permitted to administer medicines.
Staff were informed about people’s medical and mental health needs and noticed if they were behaving in ways that were unusual for them which might indicate that they felt unwell. Referrals were made to other health professionals as needed. This included GPs, dentists, opticians and the mental health team. District nurses visited to carry out any wound care needed.
The premises were suitable for their purpose and provided people with large communal areas and a secure garden. Relatives had commented on survey forms that the ‘Décor is looking a bit tired’ , and ‘The décor needs a bit of updating’, and this corroborated our own findings. There were areas of scuffed and damaged wood work on stairs, doors and skirting boards which detracted from the overall impression of the service. The provider had a business plan which included carrying out improvements to the décor.
Staff enabled people to make choices about their lives where they were able to do so. This included getting up and going to bed when they wished; and choosing their clothes, their meals and their activities. People were given different choices at meal times and could have snacks at any time. The menu was changed at intervals to take account of people’s preferences and changing seasons.
Staff had caring and kind attitudes and provided a calm and friendly atmosphere. People and their relatives were given clear information about the service at the time of admission, and discussions were carried out with them about their care planning and any changes needed. Some people lacked mental capacity to make decisions or had fluctuating capacity, and were supported with decision-making. This followed agreed protocols to involve their next of kin or representative, and health and social care professionals, to make decisions on their behalf and in their best interests.
Staff were fully informed about the importance of applying the Mental Capacity Act 2005, and to enable people to make decisions within their capacity. People’s care plans were person-centred, and were discussed with people and their relatives as appropriate. Separate care plans were written for each aspect of care, and monthly reviews were carried out. People’s family members were invited to take part in reviews if they wished to do this.
People were supported in carrying out activities of their choice, and staff were mindful of people’s individual needs and wishes. There was a range of individual and group activities available and carried out by all the care staff in accordance with what people wanted. An activity planner was in place for group activities, but this was flexible depending on what people wanted to do.
People were informed about the service’s complaints procedure and this was clearly displayed. There were systems in place to monitor and follow through minor concerns as well as complaints. The records showed that people’s views were taken into account, were listened to, and changes were made in response where needed.
The staff team was led by a registered manager who demonstrated detailed knowledge of the people and their support needs. The registered manager and the deputy manager spent as much time as possible working alongside the staff team, giving them a clear lead. Staff showed thoughtfulness and respect for each other as well as for the people living in the service, and worked well together as a team. Staff were encouraged to raise ideas and felt valued and supported.
The registered manager and the providers carried out monthly audits to monitor the progress of the service, and took action in response to their findings. People’s relatives and visitors were asked to complete surveys for their views of the service and these had provided positive responses during 2015. Records were well maintained and were kept up to date.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.