An unannounced inspection took place on the 19 November 2015. The inspection continued on the 20 November 2015 and was announced. It was a planned comprehensive inspection carried out by one inspector.
The service is registered to provide accommodation and residential or nursing care for up to 11 people. The service does not providing nursing care. At the time of our inspection the service was providing residential care to 11 older people some of whom were living with a dementia.
The service provides accommodation over two floors. All the bedrooms are single occupancy and six have an en-suite toilet and wash basin. On the ground floor there are shower facilities in a wet room and on the first floor a bath. The first floor can be accessed via a central staircase or a lift. Each room has a call bell system that people could use if they needed to call for assistance. On the ground floor there is a communal lounge, dining room and a small conservatory. The porch area looks onto the front driveway and has seating that people also use to meet with friends and family. On the ground floor there is a well-equipped kitchen a small laundry that has one washing machine and one dryer and a sluice. Large items such as sheets are sent to an external laundry for ironing. The front door is kept locked and visitors need to ring a bell to get staff to let them into the building. Outside there is a small area at the front of the building which is used for parking. The service does not have any outdoor sitting areas.
The service had a registered manager. 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.
We found that the service was not always safe. Peoples care files had risk assessments completed for skin care, malnutrition and moving and handling. In some cases the completed assessments showed that a person was at risk but no care plans had been put in place to detail what actions were needed to minimise the risk. Some care plans that were in place did not reflect the care that was actually being provided.
People did not have personal fire evacuation plans in place. Fire alarms and equipment had been checked weekly. Since January 2014 records showed us that a fire door into the lounge had a fault and had not been closing correctly. No action had been taken to repair the fault. Maintenance records for the lift, boiler and hoists were up to date. An emergency contingency plan had been put in place in the event of the service needing to be evacuated.
The building had a central staircase which accessed bedrooms on the first floor. A risk assessment had not been completed to consider whether people were at risk of injury and whether actions were needed to minimise any identified risks.
Medicine was administered safely by staff. One person self-administered their medicines. A risk assessment had not been completed to show how any risks to the person or others had been minimised.
People who lived at the service, their families and other professionals told us they felt the service was safe. Staff had received training in safeguarding and understood how to put this into practice.
Staff were recruited safely which included criminal records and eligibility to work in the UK checks. Processes were in place to identify and manage unsafe staffing practice.
We found that the service was not always effective. They were not fully working within the principles of the Mental Capacity Act. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).
We were told that some people were living with a dementia. MCA had not been carried out to determine whether people were able to consent to restrictions on their liberty or if a DoLs application was required in line with the MCA legislation. Staff were verbally seeking a persons consent before providing any care or support. They had undertaken MCA and DoLs training but required a better understanding of the practical application of the legislation.
People enjoyed home cooded meals and were offered choices. Staff discreetly provided support people to at mealtimes and encouraged and supported people to maintain their independence. At the time of the inspection nobody required a special diet or had a swallowing pla in place.
Staff received appropriate induction and on-going training which included dementia awareness, dignity and person centred care, malnutrition, food hygiene, medication administration, moving and handling and safeguarding. A number of staff had achieved NVQ2 and 3 qualifications.
People had good access to healthcare. This included GPs, district nurses, chiropodist, optician, audiologist and specialist services at the local hospitals.
We found that the service was caring. People, their families and other professionals all told us they felt the service was caring. People felt that the staff had a good understanding of their care needs. Staff responded quickly when asked for assistance. Care was provided in an unhurried, relaxed and friendly way and staff encouraged and supported people to be as independent as possible. People were involved in decisions about their health and care. Staff understood how to respect a person’s dignity and privacy. An advocacy service was available when needed.
We found that the service was not always responsive. People did not have care plans for all their identified care needs. One person had care plans that had conflicting information in them. Care plans did not always reflect what was actually happening in practice which placed people at risk of inconsistent care or not getting the care and support they needed. People and their families had been involved in assessments and planning their care prior to moving to the service. People were not always involved in continued care and support planning.
Staff were kept informed through handovers and a communication book about any changes with people. Health professionals told us that the service respond quickly to changes in people’s health and contact them quickly and appropriately.
People had activity profiles which contained information about how they liked to spend their time. Activities were organised at the service and their sister home nearby. The service had access to a mini bus once a fortnight and it was used for activities in the community. People were supported to maintain links with friends, family and interests in their local community Newspapers of people’s choice were delivered daily. People had been supported to access their right to vote.
A complaints process was in place. People and their families were aware of the process and felt able to use it if necessary. Regular meetings were held with people and their families to gather feedback on the service. Any concerns raised had been investigated and appropriate actions taken.
We found that the service was not always well led. Shortfalls we identified in managing risk, following the MCA and DoLs legislation and care planning had not been identified by the auditing processes carried out by the manangement of the service.
People, their families and staff found the manager approachable and accessible. The manager regularly worked alongside care workers and led by example. People and their families felt the manager had a good knowledge of peoples care needs. Staff felt that the manager listened to them and they felt able to share their ideas or any concerns. Staff received an annual appraisal that included looking at their achievements and setting future development goals.
Notifications to CQC had been completed appropriately and in a timely manner. A notification is the action that a provider is legally bound to take to tell us about any changes to their regulated services or incidents that have taken place in them.
The service carried out a quality assurance survey twice a year. Forms were sent to people living at the service and their families. Feedback had been gathered on cleanliness, food, décor, activities and the complaints process. The areas were rated as either good or excellent. Findings of the survey were published in a newsletter that the service published monthly.
The service had shared the last CQC report with people, their families and staff and a copy was on display in the foyer.
There was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as risks were not always identified and managed. We also have recommended that the provider explores guidance to support people in line with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report