A single inspector carried out this inspection. The focus of the inspection was to answer five key questions:Is the service Safe? Effective? Caring? Responsive? and Well-led?
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and what we learnt from the records we looked at. We spoke with four people who lived in the home and two people who were visiting relatives. We talked with three of the care staff, the cook, the deputy manager and a visiting district nurse. Records we looked at included three care records, staff training records, management audits and the service's quality assurance documentation.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
People living in and visiting the home considered the home provided a safe environment. One person said 'They're ever so good to me. They understand I get frustrated at what I can't do and that I see things that aren't there.' Another said safety came from having 'no worries here.'
All staff were up to date with training about safeguarding vulnerable people. They had a clear understanding of what constituted abuse and how to refer any concerns as safeguarding or whistle blowing issues. However, they did not have accurate knowledge about the Mental Capacity Act 2005. This was because few staff had been sent on related training. Staff showed an understanding of working with people's consent. However, there was a shortfall in training, combined with a lack of care planning to assess and therefore review people's capacity to understand and agree to receipt of care. This meant there was a risk that decisions needing to be made in people's best interest could be poorly assessed and recorded.
Is the service effective?
People received an assessment of need before moving into the home. This covered a number of standard outcomes, although skin integrity was not specifically addressed. There were risk assessments that gave some guidance on control measures to reduce risk. However, care plans were not developed from the initial assessment or from risk assessments. Staff were not provided with detailed written guidance on how to actually provide care, or what people's individual needs for social stimulation and activities were. This meant there was no basis on which to use reviews to evaluate if planned care was effective or objectives met. We have asked the provider to take action to improve care planning.
Changes in needs and in how care was to be provided, were recorded through daily care records and written updates. These were brought to staff attention through verbal handovers of information and reminders to read latest additions to care records. We found staff had a good knowledge of the immediate care needs of people living in the home. They said they experienced the handover of information as effective.
Records showed people received medical attention in a timely way when needed. Staff were quick to observe and act on indicators of ill health, including requesting GP visits. A visiting district nurse told us the home's staff made appropriate referrals and were effective in following care directions provided. However, there was a lack of specific risk assessments or care plans for pressure area care. The home did not use body maps to show clearly where any mark was observed and to track progress of treatment. We also found some information about health related care needs was unreliable. Confusing written records would make staff, especially new staff, reliant on shared knowledge that was not underpinned by clearly planned and reviewed interventions.
Is the service caring?
We saw that staff gave people friendly and individual attention. Care workers showed patience and gave encouragement when supporting people and respected their decisions.
People living in the home told us they made frequent use of the garden in good weather, for fresh air and sunshine. We saw plentiful support to people to be able to use the garden during our inspection. It was clear people experienced natural interaction between each other and staff. People were positive about their experience of meal times.
Organised activities were part of care staff responsibilities. There were resources for offering quizzes, reminiscence work and crafts. Pet therapy visits from outside were arranged regularly. Staff told us they sometimes supported people individually to go out to local shops, or the seafront. However, care documentation showed little information about people's interests. The deputy manager said it was difficult to arrange activities geared towards individual needs if they were of little interest to the majority in the home. There was no detailed planning or evaluation of how the home met individual needs for stimulation and social engagement.
Is the service responsive?
Staff were supported in delivering care by an organised training programme. They were encouraged to pursue diploma qualifications. Individual supervision was provided every two months and records demonstrated a consistent approach. This meant the effectiveness of individual staff was monitored and enhanced. In addition, the deputy manager ran a programme of information provision in special interest topics, which we saw as effective in keeping staff interested and motivated in delivering good practice.
There was evidence of effective liaison between the home and outside health and social care services. We saw that GPs were contacted in a timely way in response to medical concerns and there were contact arrangements for community mental health services. Paramedics had left positive feedback about the quality of information provided when a person was transferred to hospital, which provided for continuity of care.
There was an annual survey of people living in the home, their relatives and outside professionals who visited. The results were used by the provider to inform the following year's planning for the service. Individual matters raised were investigated and shortfalls addressed. People we spoke with, who lived in the home, said staff and management were very responsive to comments and requests.
Staff and management were readily available to people in the home, and to visitors. Staff responded readily to requests to move by people who were not independently mobile. Specialist health, mental health and social care resources were accessed when necessary. Care records showed specialist advice and care directions were incorporated into care records and followed by staff.
Is the service well-led?
The registered manager was also a proprietor of the provider company. They were well known to all people living in the home and were a frequent presence, but they delegated everyday running of care, staffing and quality management to the deputy manager. A person living in the home told us 'The owner always makes a point of speaking to me."
There was a maintenance programme for the home, which showed the quality of environment for people in the home received ongoing attention. There were daily and weekly schedules and checks for ensuring all areas of the home were cleaned to a designated standard.
Staff we spoke with felt management listened to their views and kept them well informed of developments and plans. They had a strong identity as a team working together. Quarterly staff meetings covered care and operational issues. A staff member said 'We all have an input, it's good to get things out in the air.' We found, however, that the lack of person centred care planning meant people living and working in the home could not be sure care was provided on the basis of individual and up to date information and assessment.