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Inspection Summary


Overall summary & rating

Good

Updated 29 December 2018

This comprehensive inspection took place on 30 October 2018 and was unannounced.

At our last comprehensive inspection on 25 January 2018, we rated the service as requires improvement. This was because risk assessment lacked detail and sufficient guidance for staff to keep people safe, medicine records were not always completed accurately, staff did not always follow safe infection control, people did not receive consistent support with their meals, there were limited opportunities for hobbies and activities and systems for monitoring the quality of the service was not effective in bringing about improvements. At this inspection we found the provider had made significant improvements to address these shortfalls, although further improvements were needed to ensure people were consistently safe.

Vishram Ghar 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.

Vishram Ghar accommodates up to 44 older people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing short term care to people who are under assessment following illness, injury or hospital discharge. The second unit support people who require long-term care, some of who were living with dementia. At the time of our inspection there were 39 people using the service.

A registered manager was in post at the time of the inspection. 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.

There were enough staff to meet people's needs. However, staff were not always deployed effectively to provide people with consistent support and engagement.

There were improvements to protect people from the risk of infections. However, these were not fully embedded into all staff working practices.

Staff understood how to protect people from the risk of abuse and procedures that should be followed to report suspected abuse. People had risk assessments in place to cover any risks that were present within their lives, whilst also enabling them to be as independent as possible.

There were safe systems in place for the administration of medicines and people received their medicines as prescribed.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

People received effective care and support from staff that had the skills and knowledge to meet their needs. Staff attended training where they completed mandatory training and received on-going training to enable them to fulfil the requirements of the role. Staff felt well supported by the registered manager and deputy managers.

People were able to choose the food and drink they wanted and staff supported people with this. Further development of the meal service was planned to ensure the serving of meals was efficient. Staff supported people with health appointments where necessary. Health professionals were involved with people's care as and when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice. People were encouraged to make decisions about their care, daily routines and preferences. Staff worked within the principles of the Mental Capacity Act 2005.

People were cared for by a staff team who were friendly, caring and compassionate. Positive relationships had been developed between people and staff. People were treated with dignity, respect and kindness.

P

Inspection areas

Safe

Requires improvement

Updated 29 December 2018

The service was not consistently safe.

Staff were not always deployed effectively or safely to provide appropriate supervision and engagement for people.

There were improvements in systems and processes for preventing the control of infection but these were not consistently followed by staff.

There were risk assessments in place to mitigate any identified risks to people.

People were protected from abuse and harm by staff who knew their responsibilities for supporting them to keep them safe.

The provider had robust systems in place to ensure lessons were learnt from incidents and accidents in the service.

There were safe systems in place for the administration of medicines and people received their medicines as prescribed.

Effective

Good

Updated 29 December 2018

The service was effective.

People received support from staff who had the skills and knowledge to meet their needs.

People were supported to make decisions and choices about how their care was provided.

Staff enabled people to access appropriate healthcare services and supported people to have sufficient amounts to eat and drink.

Caring

Good

Updated 29 December 2018

The service was caring.

People were treated with dignity, kindness and respect by staff who recognised and protected people's diversity and right to equality.

Staff supported people and their relatives to be involved in planning their care and making decisions about how their care was provided.

Responsive

Good

Updated 29 December 2018

The service was responsive.

People received care that met their needs and records were up date and regularly reviewed to ensure they reflected people's current needs.

People were able to participate in activities, though these were not always provided consistently.

People had information on how to make complaints and the provider had systems in place to deal with complaints.

Well-led

Good

Updated 29 December 2018

The service was well led.

The registered manager was developing an open and inclusive culture focussed on providing personalised care.

Systems and processes were continuing reviewed and developed to ensure effective systems in place to monitor the quality of the service and action was taken whenever shortfalls were identified.

People, relatives and staff were encouraged to give their feedback and be involved in the development of the service.