Background to this inspection
Updated
27 February 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 23 and 27 January 2015 and was unannounced. The inspection team consisted of two inspectors and an expert by experience in dementia. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection we reviewed information we held about the service including notifications. A notification is information about important events which the service is required to send us by law. We also reviewed the action plan that the provider sent us following our last inspection, describing how they would meet the requirements of the regulations.
We spoke with 20 people living at the home and five family members. We also spoke with a senior representative of the provider, the registered manager, the deputy manager, five senior care staff, 14 care staff, three catering staff and two housekeepers. We looked at care plans and associated records for eight people, staff duty records, three recruitment files, records of complaints, accidents and incidents, policies and procedures and quality assurance records. We observed care and support being delivered in communal areas. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. Following the inspection we received feedback about the home from a community nurse.
Updated
27 February 2015
This inspection took place on 23 and 27 January 2015 and was unannounced. The home is a large building based on three floors. It provides accommodation and personal care for up to 50 people, including people who were mostly independent and people who were living with dementia. There were 49 people living at the home when we visited.
At our last inspection, on 8 and 14 April 2014, we found people on the middle and upper floors of the home were isolated and their call bells were not responded to quickly. We set a compliance action and the provider wrote to us telling us how they would become compliant with the regulations.
At this inspection, on 23 and 27 January 2015, we found improvements had been made, but the home was not meeting the requirements of all regulations.
People’s safety was compromised in some areas. There were not always enough staff to meet people’s needs. Staff responded more quickly but they often had to wait more than 10 minutes for support. Many people on one floor of the home had high levels of dependency and staff felt they were “run ragged” trying to meet people’s needs.
Medicines were not stored at safe temperatures. Those that needed to be taken before food were often not given until after people had eaten. There was a lack of information about when “as required” medicines should be given. Medicines were not always recorded correctly when given. Staff did not have access to information to help them identify when people were in pain and assess what pain relief was needed.
Whilst most care plans were up to date, some did not reflect people’s current needs. Information about supporting people who displayed behaviours that challenged was not always adequate to allow staff to support the person appropriately and consistently. A wide range of activities was provided for people, but there was little provision at weekends or for people who spent their time in their rooms.
Most risks were managed safely. However, a person who was at risk of choking was not having their drinks thickened as required, which put them at risk of harm. Changes were not always made following the analysis of incidents. For example, there were seven occasions over the past year when people had left the home unaccompanied and were put at risk. Action taken to address this had not been effective.
The provider had a system in place to regularly assess and monitor the quality of service people received. However, this had not identified all of the above concerns. The provider did not tell us about incidents of abuse when they needed to, although they did inform the local safeguarding authority and take appropriate action.
Most people felt safe at the home. Staff had received training in safeguarding adults and knew how to identify and prevent abuse. The process used to recruit staff was safe and ensured staff were suitable for their role. Risks of people falling or developing pressure injuries were managed safely. Equipment, such as hoists and pressure relieving devices were used safely and in accordance with people’s risk assessments.
People were offered a choice of nutritious meals and drinks. They were encouraged to eat and drink well and staff provided one to one support where needed. People were referred to GPs, community nurses and other specialists when changes in their health were identified.
Staff followed legislation to ensure people’s rights were protected when decisions about their care were taken. Any restrictions placed on them were done in their best interest using appropriate safeguards.
Staff understood the needs of older people, including those living with dementia and knew how to care for them effectively. Most staff were supported appropriately in their role and received one-to-one sessions of supervision. However, few had received appraisals to assess their performance.
People were cared for with kindness and compassion and staff showed concern when they were not always able to meet people’s needs. In most cases they responded appropriately when people needed support but were focussed on tasks and were unable to spend time with people.
People (and their families) were continually involved in assessing and planning the care and support they received. Support was provided in accordance with people’s wishes and their privacy was protected. Daily care records relating to re-positioning, eating, drinking and continence were up to date and confirmed people had received care in a personalised way.
The home had a registered manager in place. 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. The registered manager sought feedback from people and made changes as a result. There was a complaints procedure in place which was followed.
There was a clear management structure in place for care staff. However, some care staff expressed concerns about the guidance they received from senior carer staff and at times they were not well organised. Most people felt the home was well-led.
We have made a recommendation about creating suitable environments that support people living with dementia.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have taken at the back of the full version of the report.