Over the last few months Sandwell local authority and Clinical Commissioning Group (CCG) who monitor and fund the majority of adult social care services had concerns regarding the care and welfare of some people who lived there. The concerns included, a sudden death of a person who lived there, care planning, record keeping and some issues regarding the management of medication. As a result the provider agreed to a voluntary suspension of new placements. The local authority then determined a gradual improvement had been made and agreed that the provider could partially lift their suspension to allow one new admission every two weeks to the home. The CCG suspended their intermediate care contract.
At the time of our inspection 18 people lived at the home (although as one person was away on holiday so only 17 people were actually there). During our inspection we spoke with seven of those people, six relatives, six staff, the manager, and the registered provider. All of the people who lived there and their relatives were very positive about the home and the services provided. One relative said, 'It is excellent. Much better than the last place they were in'. Another relative told us, 'I have no concerns at all. It is a very good place'. One person who lived there said, 'I like living here. I give it nine or 10 out of 10'. A second person told us, 'Oh it is wonderful here'. We randomly looked at recently completed surveys that had been sent by the provider to people who lived there, relatives, external health care professionals and staff.
We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
All people we asked told us they felt safe. All people and relatives that we asked told us that they had not seen anything of concern. One person told us, 'The staff are not rough or unkind'. One relative said, 'A member of our family visits every day. Nothing like that has happened'.
Staff we spoke with knew of Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury.
We found that people's risks and needs had been assessed. However, instructions in care plans regarding the frequency of the checking of people's wellbeing were not always followed by staff.
The management of day to day risks and safety should be improved upon. Those include systems to prevent dehydration and malnutrition.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping people safe.
Is the service effective?
Systems regarding menu planning and meal variety were effective. All people we spoke with told us that the meals were good. One person said, 'I love the food here'.
Most of the non-compliance we determined had already been raised with the provider by external care agencies. (Non-compliance is when the provider does not meet the requirements of the law or there are shortfalls in care delivery or practice). Although the provider had made some changes we still found non-compliance in day to day basic practice. This did not give assurance that the provider was adequately effective.
People's health and care needs were assessed but they were not always included in detail in their care plans. For example, staff practice for one person did not reflect the instructions in their care plan. When we asked staff to clarify what was required we were given different views. This meant that care plans were not able to consistently support staff to meet people's needs.
We found that day to day activity provision was not adequate to meet people's needs. One person said, 'There is not much to do'.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care planning to ensuring that the service is effective.
Is the service caring?
We determined that staff showed people respect and promoted their dignity. We saw that staff showed patience when supporting people.
All of the people and their relatives were very complimentary about the staff. They described them as being, 'Caring', and 'Kind'. One person who lived there said, 'I like all the staff. They are very kind and friendly'. A relative told us, 'I cannot fault the staff here. They are very kind and considerate'.
We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was caring.
Is the service responsive?
People who lived there and their relatives had been given the opportunity to complete satisfaction surveys. The provider told us that they were in the process of analysing the surveys and would take action and make changes where there was a need. This showed that the provider was willing to listen to the views of the people who lived there, and their relatives, to improve the overall service provision.
The provider told us that improvements had been made since external health care professionals had raised issues. Those external health care professionals had confirmed some improvements. However, our observations and the evidence that we gathered showed that staff did not always perform to the standard that was required regarding the following of instructions in care plans.
We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make to ensuring that the service is responsive.
Is the service well-led?
At the time of our inspection there was no manager registered with us. It is a requirement in law that the home should have a registered manager. The manager told us that they had made an application to register. The registration of the manager would give people who lived there greater assurance that the service provided would be consistent and well led.
Documents that we looked at and our observations confirmed that records were not all completed adequately to evidence sufficient food and fluid intake to prevent ill health. This showed that staff had not undertaken tasks as they should have done and did not give assurance that the service was well led.
We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make in relation to the management of staff and quality assurance processes to demonstrate a well led service.