1 October 2015
During a routine inspection
We inspected this service on 1 October 2015. The inspection was unannounced. Paulmay Dementia Care is a small residential home providing care for up to eight older people with dementia.
At the time of our inspection there were six people living at the service.
The service is located in a terraced house, on two floors with access to a back garden.
We previously inspected the service on 1 October 2013 and the service was found to be meeting the regulations.
Paulmay Dementia Care had a registered manager at the service. 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.
During the inspection there was a calm and pleasant atmosphere. People using the service informed us that they were satisfied with the care and services provided. We observed good quality caring and kind and compassionate interactions between staff and people using the service. This was confirmed by relatives following the inspection. People living at the service told us the management was a visible presence within the home. Staff talked positively about their jobs telling us they enjoyed their work and felt valued.
Staff were fully aware of people’s needs and their needs were carefully documented in care plans. Staff responded quickly to people’s change in needs if they were physically or mentally unwell.
Care records were individualised and reflected their choices, likes and dislikes, and arrangements were in place to ensure that these were responded to. Staff were aware of and understood behaviours in the context of people’s past histories.
Care plans provided detailed information on people’s health needs which were closely monitored. People were supported to maintain good health through regular access to healthcare professionals, such as GPs and district nurses. Risk assessments had been carried out and these contained guidance for staff on protecting people.
Staff felt supported and had supervision regularly.
Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.
There were enough staff to meet people's needs.
Storage and management of medicines was not well managed. An audit of medicines as part of the inspection found errors between the medicine administration records (MAR) and medicine stocks at the service. We also observed an unsafe practice by staff in relation to the giving of medicine to one person at the service.
Staff understood the need to gain consent from people using the service before providing care. Although they lacked knowledge and understanding of the wider aspects of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This was evidenced by the front door being locked for all people living at the service without the necessary documentation in place, and so depriving people of their liberty.
There was a lack of consistency in how well the service was managed. There was evidence of regular servicing of essential facilities such as gas, electricity and fire equipment and the building was tidy and clean. However, the building was in need of redecoration and some urgent repairs were required to ensure the safety of the people living at the service. Recruitment of staff was not always managed as thoroughly as it should be.
We also found people were not always protected from the risks of infection, as there were ineffective infection control and food hygiene processes in place.
The service did not have full responsibility for the financial affairs of people living at the service but contributed to the process by keeping receipts of day to day expenditure.
The majority of the residents rarely went out of the home except for health appointments so it was important that there were leisure activities taking place within the service. These were limited to simple ball and puzzle games, listening to music, watching TV and gentle massage.
The building provided limited accessibility for people with significant mobility needs. There was a stair lift to access the upper floor. The bathrooms were not fully accessible to enable a person to use them completely independently. This was overcome by specific care arrangements for people living at the service.
We have made recommendations in relation to staff training, staff recruitment, leisure activities and DoLS.
We also found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Details of these breaches and the action we told the provider to take are at the back of the full version of the report.
We have made recommendations to the provider in relation to staff training, routine maintenance, quality assurance and leisure activities.