11 and 13 August 2015
During a routine inspection
This inspection was carried out on 11 and 13 August 2015 and was unannounced.
Whitfield is a large detached residence, which is registered to provide accommodation and care for 30 older people living with dementia. Accommodation is set over two floors. There is a lift to assist people to get to the first floor. Bedrooms are situated on the ground and first floor and there are separate communal areas. It is located in the village of Whitfield and set back from the main road that runs through the village. At the time of inspection there were 26 people living in the service.
The service had a registered manager who was present on both days of our 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.
Some people could become unsettled later in the day and staff were aware this happened. When staff identified an incident, they were able to resolve any situations. Staff knew how to support people if they became upset or agitated, but did not always record these incidents to monitor and review these in order to help prevent the potential for reoccurrence.
People were weighed on a regular basis. Some people had lost weight and had not always been referred to a dietician or other health care professional when this happened. However, actions were taken when weight loss was identified at inspection.
The risk of falls were not always managed safely to protect people from falling again. One person had not been referred to a healthcare professional such as the falls clinic staff. Other people had been referred, but were still at risk of falls. Accidents and falls were not looked at in detail to identify patterns or trends which could help prevent or reduce the likelihood of further accidents.
Medicines were not always managed safely; some medicines were not stored safely or dated to make sure they were safe to use. Safe systems were not in place for ‘as and when’ medicines to make sure these medicines did not have any adverse effects on prescribed medicines. Some checks that staff completed had not identified these shortfalls. Systems to keep the environment clean were not robust. Cleaning routines and checks completed did not include equipment such as commodes; which were unclean.
People were assessed before they moved in, although some of these assessments lacked detail. Care plans had not always been updated to ensure that staff were given information about people’s current needs. However, staff knew each person well and how to support the person.
Most people’s relatives felt they were kept informed about any changes in the needs of their loved ones. Although one relative did not know about a referral to a health care professional which would have helped to reduce any concerns they had about the health of their family member.
People were supported to make choices and be involved in their care. People’s relatives were involved and included. People’s preferences such as their likes and dislikes were considered when the care was planned to ensure staff knew and understood them. Staff treated people with dignity and respect.
Staff understood the principles of the Mental Capacity Act (MCA) 2005, although these were not always followed. Some people’s assessments were not carried out in accordance with the MCA code of practice.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Applications had been made to the proper authorities to ensure that people were not deprived of their liberty unlawfully. Recommendations made by these authorities were followed to support people to live without unnecessary restrictions.
Activities were limited because the activity coordinator only worked part time. Care staff supported people to do things they enjoyed and outside entertainers, such as singers, visited the service.
People were offered and received a healthy and balanced diet. There were a range of different meals to choose from and everyone we spoke with told us they liked the food.
There were enough staff available to provide safe and effective care to people. Staff had time to engage with people and to respond to calls for assistance. Recruitment procedures were effective and new members of staff were assessed to be safe to work with people. Staff had received the training they needed to support people. Shortfalls in staff’s moving and handling training had been recognised and further training and competency checks were being completed.
Staff were aware of their roles and responsibilities. Staff told us people were ‘the heart of the service’. Staff we spoke with told us that people who lived at the service were ‘the most important part of everything we do’.
There were systems and processes in operation to support people and their relatives to make a complaint or raise concerns. Complaints were acted on and responded to within the provider’s timescales. People’s relatives told us they, ‘felt confident’ to speak with the registered manager at ‘any time’.
People’s views were sought through questionnaires and conversations with staff. Staff responded when people made specific requests. People’s relatives felt that the registered manager and staff were supportive and listened to what they had to say.
People were protected from the risk of abuse. Staff knew how to keep people safe and who to report any concerns to. There was an open and transparent culture where staff felt able to have a say and raise any concerns if they felt they had to.
Individual emergency evacuation plans had been produced and staff knew how to keep people safe if they had to use emergency procedures.
The registered manager led the service well, so people, their relatives and staff were confident in the way the service was managed.
We found 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.