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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

There should be enough members of staff to keep people safe and meet their health and welfare needs (outcome 13)

Not met this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

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

There were not always sufficient numbers of suitably qualified persons with the right skills on duty to meet the needs of the people living at the home and people’s needs were not always met in a timely way.

Regulation 22

Reasons for our judgement

During this inspection we observed there were not always enough qualified, skilled and experienced staff to meet people’s needs. We had some concerns that people’s needs and preferences were not always being met. We raised some concerns during one of the SOFI observations regarding some of the staff practices. During our observations in the lounge and dining room we saw times where there were shortfalls in the number of staff available to meet people's needs.

We observed the following; two people asked for the toilet and were asked to wait. The staff were heard explaining they were busy and said to one person, "Can you give me a minute"? Two people were asked to wait to have their soiled clothes changed. One person was not supported by staff or made aware they had a cup of tea awaiting them; they refused to drink it when they were alerted because it had gone cold. A staff member had to walk away from supporting one person to assist another. We saw some people had minimal or no staff interaction and their behaviour appeared to show they were ‘bored’. One person told us, “The staff don’t make a point of sitting down and chatting with me, I get fed up”. The manager told us this was due to the deployment of the staff team. We observed that the nurse on duty spent a lengthy time administering medication to all people who used the service and carrying out ‘nursing tasks’ as required. This left little opportunity for the nurse to role model good practice or to support the care staff.

People who used the service had mixed views about the staffing levels in the home. Five of the eight people we spoke with said that although they saw that staff were always busy, their response to requests for assistance was generally good. Three of the ten people we spoke with commented that they sometimes had to wait variable amounts of time to be assisted to use the toilet. One person told us, "I feel that due to staff shortages, my dressings were not changed as frequently as they should have been” and “Quite often the staff are very busy. This means that I might have to wait a long time for someone to take me to the toilet”. Another person told us, "I do have to wait sometimes; I try and ask in advance because I know staff are busy". The manager told us she would look into the issue in relation to the person’s dressings.

When people were demanding the attention of staff, demonstrating behaviours that challenge (due to their mental health needs) staff were not always seen to use appropriate techniques to manage and support them in a professional manner. We heard staff asking a person to repeatedly ‘sit down’; they were clearly becoming increasingly agitated. We spoke with staff about the training they had received. Staff told us they had been told about different types of dementia but the training did not include how to manage people with dementia or challenging behaviour. The provider might like to consider people would benefit if staff had training specific to dealing with people dementia.

The three people’s relatives we spoke with were positive about the care their relatives received. One person’s relative told us, “It depends if my relative gets taken out because of the number of staff available, that can be a worry because they like to get out”. We saw that people looked relaxed in the company of staff.

At the time of our inspection the home had 25 people accommodated. The manager told us this included 11 people with dementia. Staff on duty comprised four care assistants including one senior, one registered nurse, the manager, the activities coordinator in the afternoon, the chef and two members of the housekeeping team. The team were supported by an administrator, maintenance person and kitchen assistant. The previous two weeks duty rotas showed this number of staff had mostly been maintained.

It was evident that a number of people had dependency needs that included using the hoist for moving and handling, nursing needs and needed suppor