Archived: Sloe Hill Residential Home

Sloe Hill Residential Home provides support with personal care for older people, some of whom live with dementia. Sloe Hill Residential Home accommodates 28 people in one adapted building. At the time of the inspection there were 19 people receiving personal care.

People’s experience of using this service and what we found

People felt safe having their care provided by staff at the service. Risk assessments were in place to identify possible risks to people`s health and well-being. However, we found for one person appropriate, risk assessments were not in place.

The home remained clean throughout the inspection and staff received appropriate infection control training. However, cleaning schedules were not in place to allow the registered manager to monitor infection control appropriately.

The provider had not ensured the environment was dementia friendly to promote people’s wellbeing. We have made a recommendation about dementia friendly environments.

Staff understood how to keep people safe and report any concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff worked in conjunction with guidance from external health and social care professionals across different organisations to help promote people’s well-being.

Staffing levels were reviewed to make sure they were satisfactory to meet the needs of the people using the service. Medicines were safely managed.

Staff knew the people they supported. Staff received regular training, supervisions and appraisals. People were supported to maintain their independence. Staff promoted people’s food and drink intake.

Staff promoted and maintained people’s privacy and dignity. People had developed good relationships with staff who had a good understanding of their individual needs and preferences.

People and their relatives told us staff were kind and caring. People`s personal information was kept confidential. People and their relatives were involved in discussions about their care and felt that staff and the registered manager knew them well. People told us if they had to raise any concerns, they would be confident they would be listened to and the concern resolved where possible.

Staff felt supported. Audits were carried out to monitor the service. The registered manager notified the CQC of incidents that they were legally obliged to.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 29 June 2018) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sloe Hill Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 28 people in four adapted buildings. At the time of the inspection there were 24 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

With effect from April 2015 providers who have been awarded CQC ratings must display them in each and every premises where a regulated activity is delivered, in their main place of business and on their website.

Ratings must be displayed legibly and conspicuously so that the public, and the people who use the services, can see them. We found that the rating on the provider’s website had been displayed in a way that may be misleading to the public.

There were systems in place to monitor the quality of the home. The management team had embraced monitoring systems and were working on ways to develop them further. However, these systems had not resolved all the issues found on inspection.

People had their individual risks assessed. However, these were not always reflective of changes in people’s needs. Staff knew how to recognise and report any risks to people’s safety, this included fire safety. People’s medicines were managed safely.

People and staff were positive about the running of the home, the registered manager and the provider. There was a complaint’s process which people and their relatives knew how to use. People and their relatives were confident that they would receive feedback from the registered manager.

There was sufficient staff to meet people’s needs, however, staff had not always been recruited safely.

People were supported by staff who had received updates to their training and who felt supported.

Most people were supported in accordance with the principles of the Mental Capacity Act 2005, however, for one person the process had not been followed robustly.

People were addressed by staff with respect and kindness. People’s privacy and dignity was always promoted and confidentiality was promoted.

People received care in a person centred way although activities provided could be further developed to reflect people’s individual hobbies and interests. People and their relatives were involved in planning their care but they did not always take part in reviews of their care. People gave us mixed views about the food but we noted the mealtime experience was pleasant. People had regular access to health care professionals.

This inspection was carried out on 9 May 2017 and was unannounced. At their last inspection on 14 October 2016, they were found to not be meeting the standards we inspected. At this inspection we found that they were not meeting the standards, and there were areas that required improvement.

Sloe Hill Residential Home provides accommodation for up to 28 older people, including people living with dementia. The home is not registered to provide nursing care. At the time of the inspection there were 24 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People felt safe, however, staff knowledge in relation to reporting concerns externally needed development. We also found that staff knowledge in relation to fire safety needed further development. Storage of gloves, aprons, continence products and cleaning of commode pots was also an area that required improvement. Although the rating awarded at their last inspection was displayed on their website, it was not displayed in the home.

Individual risks were assessed and staff worked in accordance with the assessments. People’s medicines were managed appropriately. People told us there were enough staff and these were recruited safely.

People were supported by staff who were sufficiently trained and felt supported. The service worked in accordance with the principles of the Mental Capacity Act 2005. People received a varied and balanced diet and there was regular access to health and social care professionals.

People were treated with dignity and respect. People were involved in their care and preferences were promoted. Confidentiality had improved, however records needed to consistently stored securely.

People received care that met their needs and their care plans were detailed and person centred. Activities were provided but these needed further development. People knew how to make a complaint but there had not been any recent complaints. People, their relatives and staff were positive about the management team. Systems had been developed to help monitor the quality of the service.

Sloe Hill is registered to provide accommodation for up to 28 people. The home provides support with personal care for older people, some of whom live with dementia. At the time of the inspection there were 24 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People told us they felt safe. People’s medicines were administered as prescribed but records and systems required improvement. Accidents and incidents were not analysed to help identify themes and trends. We also found if a person sustained an unexplained bruise or skin tear, these were not investigated or reported. In addition, staff knowledge in regards to safeguarding people from abuse needed development. We also found that some of the principles of MCA and DoLS were not followed.

The systems in place to monitor the quality of the service and address any shortfalls was not consistently effective and staff did not feel listened to. We also found that they had not displayed the awarded rating accurately on their website and it was not displayed in the service in accordance with the rating they had been given. However, people and their relatives were positive about the service and the management team.

People told us they were supported by enough staff who were knowledgeable, but they were busy. However, this needed to be reviewed using an appropriate dependency tool. Staff told us that they felt staffing at the service was an issue. They also felt they did not receive enough training. The appropriate recruitment checks were carried out.

People had a healthy and balanced diet and there was regular access to healthcare professionals. People and relatives told us staff were kind and that they were involved in the planning of their care. Although we found staff were discreet and respectful, care plans were not always held securely.

People received care that met their needs and had care plans in place. There were activities and outings available that people enjoyed. Complaints were investigated but the process needed further development to ensure all feedback to complainants was captured.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

People had been cared for in an environment that was safe. People's care plans reflected their individual needs and regular reviews and staff hand overs ensured good safe care. One person said, 'I definitely feel safe, oh yes I get good care.'

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs were being met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs. 'One person who used the service said, 'I am happy here, very good, very helpful, very cheerful. They [staff] are excellent.'

Is the service caring?

People were supported by kind attentive staff. We saw that staff were thoughtful and caring. They spoke to people in a polite and respectful way. We observed good interaction between staff and people who used the service. One relative we spoke with said, 'I know my [Name] is safe. When I leave I don't have to worry because she is cared for well.' One person said, 'Staff are very helpful, couldn't wish for better help.'

Is the service responsive?

All people who used the service had pre-admission assessments undertaken to ensure the home could meet their needs. Their care plans were regularly reviewed and people's needs were assessed and documented, all care plans we saw had a named key worker. There were lots of activities for people.

At a resident's meeting, it was noted that plates were not warmed before serving the food. This had now been resolved; the kitchen now used a hot plate. One person said, 'I was asked by the provider was everything ok, I told him that it was except I didn't like the sausages they used. The provider has changed them for me.'

Is the service well led?

Staff were well led and up to date with their training, there were quality assurance processes in place. People's views were sought verbally, there were monthly resident and staff meetings and yearly surveys were sent to residents, families and advocates. People and relatives we spoke with confirmed they could talk to staff and management.

When we inspected Sloe Hill Residential Home on 09 October 2013 we saw that people were routinely asked for their consent about their every-day care and treatment and the staff acted in accordance with their wishes. We saw numerous examples during our inspection of such consent being sought through every-day conversation.

The provider did not have suitable arrangements in place to obtain the consent of people living at the home in relation to 'Do not attempt cardio-pulmonary resuscitation' (DNACPR) decisions.

We found that people's needs were assessed and care and treatment was planned and delivered in line with those individual needs. People's care plans were reviewed every month which meant that people's needs and support arrangements were up to date. One person living at the home said, 'It's really nice. Everyone is lovely. They really look after you well.' The relatives of one person told us, 'My [relative] has always been well cared for here. They know [my relative] so well now and they always know exactly what [my relative] needs.'

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. People's medicine records were accurate and reflected their medication care plans. One person confirmed that they always received their medication on time and in the correct amount.

We found that there were enough staff to meet people's needs. One person said, 'They are always around if you need them.'

People's records were stored securely. However, some of the records were not accurate. There were no end-of-life care plans for people who were subject to DNACPR decisions and there were some gaps in the repositioning charts of two people at risk of pressure ulcers.