Three inspectors, one expert by experience who had an understanding of care homes and a specialist nurse advisor carried out this inspection. The focus of the inspection was to answer the five key questions we always ask:' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.
We used a number of different methods to help us understand the experiences of people using the service. Some of the people had complex needs which meant they were not all able to tell us about their experiences. However, we observed the care being provided and spoke with twenty people who lived at the home and relatives that were visiting. We also talked with staff including three nurses, the Registered Manager of the home, the Clinical Director, the Training Manager and the Matron.
We looked at staff training and recruitment records, the provider's audits and action plans and people's care records.
The home was divided into different areas Oak, Cedar, Ash and Beech. Overall we found that the home was meeting people's needs but that improvements were needed on Oak.
Is the service safe?
People told us that they felt safe and that they could talk to a member of the staff if they had any concerns.
Discussion with staff and the records confirmed that they had attended training in safeguarding vulnerable people and were aware of the procedures to follow if they thought anyone had been harmed.
We found that each person had a care plan and associated risk assessments in place. However, we found that on Oak the care being provided did not always reflect the information in the care plans. This meant that people were at risk of not receiving the care and support they needed.
Staff and people living at the home told us and observations of care confirmed that in the majority of the home the staffing levels were sufficient to meet people's needs. However on Oak the staffing levels in the afternoon were reduced which meant that staff were rushed and the care became very task based. We discussed this with the Clinical Director and they responded by increasing the number of staff the day after the inspection.
Is the service effective?
Staff received appropriate training and support for their role, including attendance at one to one and group meetings. Information supplied by the Registered Manager showed that staff had received training in relevant topics so that they were aware of best practice.
We observed breakfast and lunchtime in all of the four areas in the home. We found that in three areas people were offered choices, had the individual support they needed and were not rushed. However on Oak we found that there was not enough staff in the dining room to give people the individual care and support when they needed it. Although people were given a choice they did not always understand the choice as it was explained and alternative methods were not used to show them the options. We also found that some people's needs were not being appropriately assessed and professional healthcare guidance was not sought which could have placed them at risk.
Is the service caring?
People told us that they were happy living in the home. One person said, 'I am very happy here. I moved from the other place as they thought I needed more care. The staff are lovely, very caring. I can have a shower if I want but I prefer a wash in bed. The food is very nice and well presented. I have no concerns'. Another person told us, 'I feel at home here, the staff are extremely nice and I am very happy here. One person commented, 'They are nice carers and we feel respected and we respect them'. The relative of one person living in the home told us, '(Name) has been coming here for four years now to give me a break and the staff they are very caring and very efficient. I do look at (their) care plan and if I ever ask for something they do their best to accommodate.'
We observed staff working with people and saw that they treated them with kindness, dignity and respect. Staff obviously knew people well and people responded positively to them.
Is the service responsive?
Where people had capacity to make decisions for themselves, we found that staff consulted them before providing their care. Records showed that some people had been involved in writing their care plans.
The care plans that we looked at were detailed and contained information about how people should be supported and their preferences. Care plans were being regularly reviewed although we found that the reviews had not always picked up areas that needed updating or further investigation.
Activities were regularly organised in the communal areas and the daily activities staff also spent time on a one to one basis with people who did not wish to participate with group activities.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that staff had received training in the MCA and the DoLS, and there were procedures in place to ensure that people who could not make decisions for themselves were protected. Capacity assessments had been completed and DoLS applications were in the process of being considered for anyone that needed it.
People told us that staff responded when they called for assistance and we saw most people had call bells within easy reach.
Is the service well led?
There was a Registered Manager in post, a Matron and a Clinical Director who was responsible for line managing both of the homes on the same site.
We found during this inspection that the area that needed improving was Oak. This also reflected the finding of our previous inspection. The Registered Manager stated that they were aware that work needed to be done to improve the outcomes for people living on Oak and that the home had recently signed up to a dementia pledge which they thought would enhance the quality of life for people living with dementia within the home. However there was no specific action plan to highlight what action was going to be taken to improve the care and support.
Although the Registered Manager responded to our feedback and took appropriate action about the staffing levels in the afternoon and at mealtimes the care staff told us that they had raised these issues before but no action had been taken.
The Registered Manager told us and staff confirmed that any issues could be discussed and that staff had been made aware of the whistle blowing procedures if they didn't want to raise concerns internally.
We found that although audits were in place these were not always used to ensure that improvements were made. For example although safeguarding reports had been seen by the Registered Manager these had not been fully analysed or evaluated to establish cause; identify any trends or themes and continually review practice. Whilst in some cases investigations were being, or had been, undertaken in relation to the conduct of some staff, there was no system in place to develop solutions and risk reduction actions to protect people and ensure future lapses were minimised.