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Inspection report

Date of Inspection: 15 May 2014
Date of Publication: 11 June 2014
Inspection Report published 11 June 2014 PDF


Inspection carried out on 15 May 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected and this is a summary of what we found;

Is the service safe?

People who used the service were safe because staff had received training on how to recognise the signs of abuse and possible harm, and they knew what to do if they had any concerns. Where safeguarding concerns had been identified, the registered manager and staff worked closely with other professionals to ensure they acted to reduce the possibility of future harm occurring.

We saw that records included an assessment of need which included information about people�s physical, psychological and environmental needs. There were risk assessments that related to specific and identified risks to people's safety. They contained actions to be taken by staff to minimise the identified risks including the use of any equipment. This meant that people who used the service were protected against receiving inappropriate or incorrect treatment.

The registered manager and staff understood The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw where people no longer had capacity to make specific decisions, the staff acted appropriately and decisions were made in people�s best interests. Evidence was obtained to ensure where family and friends had the legal authority to make decisions on other people�s behalf, appropriate procedures had been followed. No DoLS applications had been completed, though the manager knew when an application should be made and knew how to submit one. This meant people could be confident that decisions were being made in their best interests and only by people who had suitable authority.

Is the service effective?

Each person had care records which included an assessment which was completed when they started using the service, and people were asked how they wanted their care provided. The care records included a support plan, although this did not always reflect the actual care and support we observed during our inspection. We saw information about how people should be supported to eat and drink was not always accurate, and we saw people were given drinks containing milk even though staff believed this should be limited. We looked at the records and spoke with the registered manager about our concerns as some information for diet and nutrition was unclear. We saw this had resulted in care that was not consistent and may not be in people�s best interests.

We spoke with three members of staff who told us they received formal supervision and appraisals of their work. Supervision is a vital tool used between an employer and an employee to capture working practices. It is an opportunity to discuss on-going training and development. One member of staff told us, �We meet with the manager and can talk about how everything is and whether we need any more training. Whenever we need something they always arrange it.� Another member of staff told us, �We work together and help each other out. We have to work well to support people.� This meant that staff�s performance and development needs were regularly assessed and monitored.

Is the service caring?

During our inspection we observed staff interactions with people who used the service in the main lounge and spoke with three people and a visitor. We did this to understand whether people were receiving good quality care that met their individual needs. We saw that people were at ease in the presence of staff and staff knew people well, and were able to talk and share experiences. People we spoke with told us the staff were friendly and kind. One person told us, �They are all just so lovely. They put their heart and soul into their job.� Another person told us, �One of the reasons I chose here was because the staff were so friendly and I wasn�t wrong.�

During our observations we saw some staff interactions that caused us concern and we discussed this with the registered manager during our inspection. We saw staff did not always ask people what they wanted, including how they wanted their drink and whether people wanted the windows and doors open. We saw that one person was moved nearer to the dining room table in their chair without any warning or discussion with staff. We saw that this distressed them. The registered manager agreed that these interactions needed to be reviewed to ensure that all people were cared for in a dignified way at all times.

Is the service responsive?

We saw accidents involving people falling were reviewed and where concerns were identified, the registered manager consulted with health care professionals to reduce further falls and potential harm. We saw that people received additional support to prevent further falls. We also saw that equipment was available to enable people to mobilise safely around the home. This meant people received the support and equipment needed to respond to identify concerns about mobility and prevention of falls.

People had access to activities in the home which were carried out by staff. On the day of our inspection people could have their hair cut and styled, and there was music and songs from the 1940�s being played and sung to. We saw there were reminiscence memorabilia which staff told us they used to talk about past events. One person who used the service enjoyed playing the piano for people, and there were entertainers organised who visited the home. The registered manager told us that under the current staffing arrangements people participated in activities in the community with family or friends. People told us they were happy with the current arrangements and one person told us, �We enjoy having a chat with each other here. I like to read the paper or a book and I do enough. It�s the company I like.�

Is the service well-led?

The provider had a quality assurance system in place. Records we saw confirmed that identified problems and opportunities to change things for the better were addressed promptly. People who used the service told us they were able to attend meetings and were asked about how they wanted their care provided and if anything needed to be changed. One person told us, �The staff are always interested in what you want to do and what you have to say.�

There were systems in place to monitor how medication was managed, accidents and incidents were reviewed and monthly checks were completed including fire equipment testing and safe fire evacuation. These audits were evaluated and where required, action plans were in place to drive improvements. We saw where any deficiency or improvement was required, prompt action was taken. This meant the provider had suitable systems to assess and monitor the service provided.

There were systems in place to make sure the staff learnt from events such as accidents and incidents, whistleblowing and investigations. This meant risks to people were reduced and there was evidence that the provider used this to improve and develop the service.

The provider notified us, the Care Quality Commission (CQC), of any incidents that occurred as they were required to by law.

There was a registered manager in the service who demonstrated a good knowledge of their role and responsibilities and how to effectively lead the team of staff.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to how people can have their views and experiences taken in to account in the way the service is provided and delivered.