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Inspection report

Date of Inspection: 4 September 2013
Date of Publication: 18 October 2013
Inspection Report published 18 October 2013 PDF | 88.74 KB

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 4 September 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members and talked with staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Our judgement

People did not always experience care, treatment and support that met their needs and protected their rights.

Reasons for our judgement

People’s needs were assessed and care and treatment was planned however the risks and associated care plans were not always up to date and for two people these did not reflect the person’s current needs. We spoke with 8 people who used the service, people who were able to communicate with us told us the staff cared for them well. Two people told us they were not always satisfied as they had to wait for attention and this made them feel uncomfortable. During this inspection we observed that people did have to wait for staff. (see staffing).

Comments from people included, “I’m satisfied with the staff, I think they are good” and “I always feel safe here, the care is good”. One person’s relative told us, “I think the care is fantastic. I sometimes pop in at any time and I am always satisfied with my relatives care”. The 3 relatives we spoke with were aware of their relatives care plan and told us they felt involved in their relatives care and felt their care and welfare needs were well met. Relatives told us they would approach the manager to raise any issues and they felt they had sufficient opportunity to discuss the care and welfare of their relative.

The manager told us that some peoples care profiles had recently been reviewed and updated to include their current risks, abilities, choices and care needs. Each person had an individual file containing their care plan and other relevant supporting information. The care plans held information relating to people's medical, physical and some social care needs. The provider might find it useful to note that not all parts of the care plans looked at contained the detail of people’s personal preferences. There was a risk people's needs would not be met and the quality of care compromised if the records were not detailed and person centred. The manager showed us an internal action plan which confirmed she had recognised the shortfalls and had plans for staff to re write these in a more person centred way and to introduce more social history, this would further guide staff and support them to meet peoples individual preferences for the way care is delivered.

We observed people using the Short Observational Framework of Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We carried out a SOFI in the communal areas in the morning and during lunch time in the dining room. We saw some positive examples where care staff were interacting well with people and also where interactions were not always positive. For one person they were told on more than one occasion to ‘sit down’. This person was clearly challenging to the staff, it was evident that not all staff had good communication skills when dealing with this person and staff were unsure how to manage this person’s behaviour. We observed some people who had dementia care needs sat in their chairs, some sleeping for long periods of time with little stimulation in the morning. The provider may find it useful to note that there were not sufficient activities or stimulation to meet the specific needs of people with dementia. This meant that people’s wellbeing was not always promoted.

During the lunch time SOFI we saw that staff had to get up and attend to a person’s needs and break away from supporting another person to eat their meal. The atmosphere in the dining room was noisy and busy. Although some of the noise was healthy conversation, we discussed with the manager about managing the lunch time experience differently so the environment may be calmer for people with dementia. We also discussed about people with dementia may benefit from a less stimulating day area.

We observed staff using moving and handling equipment appropriately and were heard staff explaining what they were doing to the person they were supporting.

The records we looked at included a range of risk assessments including; pressure care, mobility, falls, nutrition and communicatio