Accommodation, nursing and personal care, is provided at this location for up to 39 older adults with nursing needs or living with dementia. At our visit, 28 people were living in the home. There had not been a registered manager in post at this service since August 2014.
There was no registered manager in post. A new manager had been appointed who advised they were commencing their registered manager application. 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.’
There were not always enough staff to meet people’s individual care needs and people did not always receive appropriate care or treatment. People were not being fully protected from risks associated with unsafe medicines practice because their medicines were not always properly stored, recorded or given.
Staff, were aware of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), but they did not fully understand or follow these when required. They did not always show whether people’s capacity to consent to their care had been properly considered or authorised, when restrictions to people’s freedom had been made to keep them safe.
Before our visit the provider told us they carried out regular checks of the quality and safety of the environment and people’s care. However we found that their checks were not wholly effective to protect people against the risks of inappropriate or unsafe care and treatment because they were not always being followed or acted on. The provider’s checks had not been consistently or proactively undertaken, which resulted in failure to identify and act on areas of concern for people’s care that we found at this inspection.
People, their relatives and most staff felt that people’s care and staffing arrangements were improving, but that staffing arrangements were not always sufficient to ensure people’s safe supervision and delivery of their care.
Staff received most of the training they needed to perform their role and responsibilities. Plans for further staff training covered most, but not all of the areas outstanding for a few staff members.
People and their relatives felt that overall, staff had established, caring and supportive relationships with them and often consulted with them about the care they provided. Most said that staff ensured people’s dignity and treated them with respect and kindness. Relatives and friends said they were made to feel welcome and comfortable when they visited the home. During the course of our inspection we saw that staff, were often caring, compassionate and respectful towards people. However, we observed some instances when staff did not always ensure people’s equality, independence, dignity or choice. We have recommended that the provider continues to review and develop there are approach to meet with recognised guidance for ensuring people’s equality and rights in their care.
People were supported to eat and drink and to maintain a balanced diet. People’s body weights were monitored and they were given foods in the consistency they required. This helped to make sure that people’s nutritional needs were being met. New menus were also being introduced in consultation with people to improve the choice of food provided, as this had been limited, particularly for people who required a soft diet because of their medical condition.
People who were able to express their views, relatives, local commissioners and some staff told us that the management of the home had not been consistent or pro-active before our inspection. All said that since the manager’s appointment, they were pleased or satisfied with some of the improvements that were being made for people’s care. People and their relatives knew how to raise concerns or to make a complaint.
Programmes for regular staff meetings and individual staff supervision had commenced. Staff understood their roles and responsibilities for people’s care. Staff knew how to raise any concerns they may have about people’s care and expressed their on-going commitment to maintaining and improving this.
Improvements had been made to protect people from harm or abuse. This included the formal monitoring of some of the known risks to people from their health conditions and the monitoring of complaints, safeguarding concerns and accident and incidents, such as pressure ulcers and falls. There were clear procedures in place for reporting the witnessed or suspected abuse of any person using the service and staff that we spoke with knew and understood these.
Contingency plans were in place for staff to follow in the event of unforeseen emergencies in the home. Since our visit the provider has assured us of some additional measures they were taking for fire safety in the home.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.