5 August 2016
During a routine inspection
This inspection was unannounced and took place on 5 and 8 August 2016. The home was previously inspected in January 2014 when it was found to be meeting the requirements at the time.
There was a registered manager in post. 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.
People told us they felt safe living at the home and with the staff who supported them. Relatives and health care professionals also felt people received safe care and attention. Staff demonstrated a good understanding of how to keep people safe and how and to whom they should report concerns. Staff had received training in safeguarding adults and knew the procedure to follow if staff suspected someone was at risk of abuse.
There were sufficient staff on duty to meet people’s care needs. We saw staff sitting and talking to people and people being assisted unhurriedly. This indicated there were enough staff on duty to meet people’s needs.
Staff were knowledgeable about people’s rights under the Mental Capacity Act 2005 to make decisions about their care and support. Staff said they supported people to be as independent as possible. Risks to people’s health and welfare resulting from their care needs were managed well through assessment and regular reviews. Where accidents and incidents had taken place, the registered manager reviewed how these had come about to ensure risks were minimised. People’s medicines were managed safely and people received their medicines as prescribed.
People and their relatives told us staff were skilled to meet people’s needs and spoke positively about the care and support provided. One person told us, “I’m very well looked after thank you very much.” Staff told us they were very well supported in their role. They said were provided with the training they required and received regular supervision and appraisals of their work performance. Robust recruitment practices ensured, as far as possible, only suitable staff were employed at the home.
People told us they enjoyed the meals provided by the home, describing them as “very good”. They said they could have drinks and snacks whenever they wished. One person said, “there’s always a choice and there’s plenty, you’d never go hungry here.” People’s nutritional needs were assessed to make sure they received sufficient food and fluids to maintain their health and people’s food preferences were recorded in their care plans. For example, one person’s care plan identified they liked to have “something small like a piece of cake and a hot drink before going to bed”. We saw people being assisted with their meals at breakfast and lunchtime. Staff sat beside each person who required support and helped them to enjoy their meal at their pace.
The home arranged for people to see health care professionals according to their individual needs. Care files contained information about people’s medical conditions and guided staff to be observant for signs of deterioration in a person’s health. Records were kept of referrals to GPs, community nurses and other health care specialists such as occupational therapists. The community nurses we spoke with during the inspection said the staff had the skills and knowledge to care for people well. One said “This is a lovely home; the staff are very friendly and caring.”
People said they were supported by kind and caring staff. One person said, “I get on very well with the staff. If you want something done they do it for you” and another said, “I’m very well looked after. Everybody is very kind here.” We observed staff being kind and respectful to people, as well as sharing jokes and general conversation. For example, one member of staff danced with a person while they were accompanying them to the dining room for lunch. Staff told us they enjoyed working at the home and they received a great deal of satisfaction from caring for people. One said, “It’s so important to support people to be as independent as possible, for as long as possible, and to make their time here as happy as it can be.”
People were able to express their views and were involved in making decisions about their care and support. Staff were knowledgeable about the people they supported and we saw people’s needs were clearly recorded in an individual care plan. The home was able to support people’s care at the end of their lives. The community nurses told us the staff care for people well at this time. Staff were responsive to people’s individual needs. For example, some people were living with mild memory loss and staff used signs to guide them to be independent within their room, such as identifying where the toilet was, or what each light switch was for. Staff recognised some people still wanted to feel useful and help with the day to day tasks around the home. They encouraged people to be involved in helping with household chores, such as folding laundry or dusting.
People made choices about where they wished to spend their time. People told us they were free to come and go from the home as they wished, but the majority preferred to spend their time in the home’s lounge area socialising with others and participating in the daily planned activities. People were encouraged and supported to maintain relationships with their relatives and others who were important to them. Visiting times were not restricted and relatives and friends were welcome at any time.
A programme of different group activities such as arts and crafts, music and singing, a magic show and armchair exercise were planned for each weekday. One person told us “I always go to the art class every week” and another said, “there is always something going on.” During our visit we saw people participating in a music session, a games session and a game of bingo.
People and relatives were aware of how to make a complaint and all felt they would have no problem raising any issues. The people we spoke with told us they had not needed to complain and that the registered manager and staff would deal with any minor issues. One person told us “There is nothing to grumble about here.” Records indicated the home had received one complaint this year relating to the temperature of a meal. This was dealt with promptly to the complainant’s satisfaction.
People and their relatives told us the home was well managed. Staff gave positive comments when asked if they felt supported and also commented on how well they worked together as a team. One said, “the staff and manager are really nice”, another said, “(name of registered manager) is very approachable and easy to talk to. There is good communication between the shifts”. The registered manager held regular resident and relative’s meetings, as well as staff meetings and the minutes showed people were able to make requests, for example about menu planning, and staff were invited to share their ideas about improving the home.
There were effective communication and quality assurance systems in place to monitor care and plan ongoing improvements. A number of checklists and audits were regularly completed and used by the registered manager to review the service. An annual survey was used to formally gain the views of people, their relatives and staff regarding the quality of the services provided by the home. The results of the survey sent in November 2015 showed a very high level of satisfaction.
The registered manager understood their responsibilities in relation to their registration with the Care Quality Commission (CQC) and was aware of their responsibility to their duty of candour. The duty of candour places requirements on providers to act in an open and transparent way in relation to providing care and treatment to people.