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Inspection report

Date of Inspection: 6 June 2014
Date of Publication: 18 July 2014
Inspection Report published 18 July 2014 PDF

Overview

Inspection carried out on 6 June 2014

During a routine inspection

There were 14 people living at Fisher Close. Most people were not able to tell us about their care and experiences because of their medical conditions. We spoke with some people�s relatives, spent time observing how staff interacted and supported people, spoke with staff about people�s care and looked at some of their care records. Below is a summary of what we found the service.

Was it safe?

We saw that staff supported people safely and mostly followed the Mental Capacity Act 2005. One person was able to consent to their care and their records showed that the provider asked them for their consent before they received care and acted in accordance with their wishes.

Two people�s care records did not properly account for their best interests. This was because they did not show the necessary arrangements, where important decisions about their care and welfare had been made by others on their behalf. This meant that where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements.

People were protected against the risks of unsafe or unsuitable premises because the provider had taken steps to ensure the home was adequately maintained and equipped and mostly suitably designed.

Arrangements were in place for dealing with foreseeable emergencies, such as in the event of a fire or accidents or serious accidents and incidents. The local fire authority had inspected the home in March 2014 and found the provider fire safety arrangements were broadly compliant with their fire safety requirement.

The manager had undertaken checks of people's care and safety and the records required for this were mostly kept up to date. They were also introducing checking systems in for medicines and infection prevention and control. This helped to ensure that people were not being placed at unnecessary risk because the provider had systems to assess and manage risks to people�s health and welfare.

Was it effective?

Staff understood people�s needs and any known risks to their safety, which helped to ensure that people experienced care, treatment and support that met their needs.

Two people�s relatives told us they (people), received the care they needed. This was independently described by both as �excellent.� One person�s relative said, �He�s been in a few homes and has been much better here.�

The provider had external management monitoring arrangements, which included a recorded annual audit. This audit was used to check the quality and safety of people�s care at Fisher Close. This was completed to show the provider�s systems that should be operating to ensure people�s safe and effective care. However, the record did not show whether these were met or whether any improvements were needed This meant it was not wholly effective in assuring the quality and safety of people�s care.

Was it caring?

Two people�s relatives told us that staff, were �brilliant� and �caring.�

We saw that staff communicated well with people, in a caring manner. Staff supported people with sensitivity, for example supporting them to move and to eat and drink. They promoted people�s privacy and dignity and helped them to make simple daily living choices. For example choice of meals and drinks.

Was it responsive?

We found there was usually enough qualified, skilled and experienced staff to meet people�s needs. We saw that staff communicated well with people, in a caring manner. They supported people at their own pace and in a way that recognised their individuality.

Work was in progress to develop approaches to people�s care. This included assessing and responding to people�s behavioural needs and developing a more person centred approach to meet people�s changing and complex care needs.

Some information was provided for people about their care in formats that were easier for them to understand. This included the use of pictures and symbols. A meals toolkit was being developed to further to assist people in choosing their meals. People�s care plans showed how they communicated their needs and instructed staff about this.

The home was comfortable, homely and equipped to meet people�s mobility and sensory needs. This included personal mobility equipment and sensory quiet rooms and equipment. All people�s own rooms were highly personalised. However, the design of the garden in Bungalow 1 restricted people�s use. This was because it was too difficult for staff to move people in their adapted wheelchairs on the soft grass and the patio area provided limited space.

We found that the provider properly responded to complaints and concerns they received. This included investigating, acting and responding to the complainant.

Was it well led?

The manager and senior staff involved people�s families, advocates and relevant health and social care professionals in people�s care when required. This helped to ensure that people�s health and social care needs were met, including for their routine health screening.

We found that the manager was consulting with staff and facilitating a review of their skills and deployment arrangements. Their stated aim was to develop proactive approaches to people�s care and to secure more flexible staff working across the three bungalows at Fisher Close for benefit the people living there.

The manager monitored accidents and incidents and errors and near misses to check whether improvements were needed to people�s care. Improvements being made included, developing care plan approaches for managing people�s behaviours that challenged others. This included the commencement of a programme of related accredited staff training.

We found that staff, were asked for their views about people�s care and treatment, and consulted about any changes. However, people�s views about their care and treatment; or their representatives where required, were not always obtained or accounted for.

One person�s care records did not fully account for their safety and welfare needs. This was because some of their personal care needs, relating to risks from their medical condition, were not being regularly reviewed. However, records showed that the manager had identified this and had instructed staff about the action to be taken and by when to rectify this.