21 November 2017
During a routine inspection
The registered manager was in attendance on both days of the inspection. 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. At the last inspection on 5 May 2015, the home was rated Good overall. At this inspection we identified two breaches of the regulations and other areas of practice that needed to improve.
Staff were not consistently following the provider’s medicine policy and this meant people were at risk of not receiving their medicines safely. A medicine administration error had not been identified. Some people were receiving PRN (as required) medicines but clear guidance for staff was not consistently provided in all areas of the home. Storage of medicines was not consistently monitored.
Some management systems were not always effective in identifying shortfalls and omissions in the quality of the service. Some records were not complete. This had led to inconsistency in some areas of practice across the home.
One area of the home specialised in providing care and support for people who were living with dementia. This part of the home had been recently refurbished and provided a clean and bright environment. We made a recommendation that the provider seeks further information about best practice in the use of colour and design within the environment to help people with dementia to orientate themselves in time and place. Staff had received training in dementia but our observations were that people were not consistently supported with meaningful occupations that were stimulating for them. We made a recommendation that the provider finds out more about providing meaningful occupation, based upon current best practice in relation to the specialist needs of people living with dementia.
Whilst there were enough staff on duty to care for people safely, the deployment of staff in some areas of the home meant that people waited longer then they should expect for their needs to be met. People in some areas of the home said it took “too long” for their call bells to be answered. Our observations were that at some times of the day staff were not always available to support people. This was identified as an area of practice that needed to improve.
Staff had received training in the Mental Capacity Act 2005 (MCA) and demonstrated an understanding of the principles of the legislation. However records did not always contain mental capacity assessments that detailed how specific decisions had been made in people’s best interests. This was identified as an area of practice that needed to improve.
People told us they enjoyed the food provided at the home. Their comments included, “The food is lovely,” and “The food is really nice.” Risks associated with people’s nutritional and hydration needs were identified. However our observations were that some people did not always receive the help they needed to eat their food. This was identified as an area of practice that needed to improve.
People told us they felt safe living at the home, one person said, “Yes I feel safe, they look after things for me.” Risks to people were identified, assessed and care plans guided staff in how to manage specific risks. Environmental risks were assessed and monitored and the home and equipment were maintained in good order and kept clean. The registered manager monitored incidents and accidents to ensure that lessons were learned and to drive improvements. Staff demonstrated a clear understanding of their responsibilities with regard to safeguarding people and knew what actions to take if they were concerned about people’s welfare. One staff member said, “I would speak up because we are here to protect the residents.”
Staff told us they were well supported in their roles and they received the training and supervision that they needed. People told us they had confidence in the skills of the staff. One person said, “The staff are well trained, sometimes they have to deal with difficult situations and they cope very well.”
Peoples’ care plans were based upon assessments of their needs and wishes. People and their relatives said they had been involved in developing care plans and that their views and opinions were considered. Staff supported people to access health care services and we saw that a range of health care professionals had contact with people at the home. One visiting health care professional told us that staff always made appropriate requests and complied with any guidance provided about people’s health conditions.
People and their relatives spoke highly of the caring nature of the staff. One person told us, “The staff are all nice people,” another person said, “The staff here are very caring.” A visiting relative said, “My relative enjoys a good relationship with the staff.” Staff were knowledgeable about the people they were caring for and described what was important to them. One person told us, “They have got to know me well, they are very kind.” People were supported to express their views and staff were using a range of methods and tools to support people who had communication difficulties to indicate their preferences. Staff demonstrated a good understanding of the importance of maintaining people’s dignity, privacy and confidentiality. People were supported to remain as independent as possible. One person told us about how they were supported to manage their own medicines.
Staff were providing care in a person centred way. One staff member said, “We get to know people very well.” A relative told us they had confidence that staff would notice any changes, they said, “I think they are on the ball in that way, they look for changes all the time.” There was a wide range of organised activities arranged by dedicated activities co-ordinators. People told us they enjoyed the activities on offer; one person said, “The staff are really enthusiastic and always encourage people to join in.”
There was a complaints system in place and the registered manager had ensured that any complaints were responded to in a timely way. One relative told us about an issue they had raised, saying, “I think they understood and will respond.”
People were supported to make plans for care at the end of their life. This included recording their wishes about where they would prefer to die and any particular spiritual or cultural needs. Staff spoke compassionately about how they cared for people in the last days of their life and described the importance of supporting relatives. One staff member said, “We can make a difference with the right planning, making the room as comfortable as possible, having music playing quietly to create a calm atmosphere and above all making sure people’s symptoms are controlled.”
People, their relatives and staff members spoke positively about the management of the home. Comments included, “It’s very well run,” and “They do a very good job.” One staff member described the registered manager, saying, “They are very caring, like everyone’s mum.” There was a clear management structure and staff understood their roles and responsibilities. Health care professionals spoke well of working in partnership with staff at the home. Staff had developed positive links within the local community including with a hospice, nursery school and local college.
At this inspection we found the provider in breach of legal requirements with regard to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.