The inspection was carried out on 16 June 2015 and was unannounced.
The service provided accommodation, nursing and personal care for older people some of whom may be living with a secondary diagnosis of dementia. The accommodation was arranged over two floors. A passenger lift was available to take people between floors. There were 40 people living in the service when we inspected.
There was a person registered with the commission as manager on the day 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. However, on the day of the inspection the registered manager was no longer employed at the service, but the provider had appointed a new manager who was applying to register.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) (MCA) Code of Practice.
Recruitment policies were in place. The manager ensured that they employed enough nursing and care staff to meet people’s assessed needs. Staffing levels were kept under constant review as people’s needs changed. However, the records kept when staff were recruited did not reflect safe recruitment practices.
The provider was not following published guidance about assessing and managing the risk of infections in care homes.
Managers ensured that they had planned for foreseeable emergencies, but the plans in place were not detailed enough to ensure that should an emergency occur, evacuation of the premises would be efficient and people’s care needs would continue to be met safely.
We have made a recommendation about this.
People’s care was responsive and recorded. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected, but care plans were not individualised.
We have made a recommendation about this.
Audits were taking place to assess the quality and safety of the service, but these were not covering all aspects of the service which had resulted in some areas being missed.
Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills. However, staff were not receiving supervisions or appraisals in line with the providers policy.
The manager and care staff assessed people’s needs and planned people’s care to maintain their safety, health and wellbeing. Risks were assessed, recorded and reviewed. However, when nurses reviewed care plans they had not always recorded that there had been a change in a person’s needs when they recorded their review notes.
People felt safe. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. The manager responded quickly to safeguarding concerns.
Incidents and accidents were recorded and checked by the manager to see what steps could be taken to prevent these happening again. The risk in the service was assessed and the steps to be taken to minimise them were understood by staff.
People had access to qualified nursing staff who monitored their general health, for example by testing blood pressure. Also, people had regular access to their GP to ensure their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.
There were policies in place for the safe administration of medicines. Nursing staff followed these policies and had been trained to administer medicines safely.
People and their relatives described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered.
Staff supported people to maintain their health by ensuring people had enough to eat and drink.
If people complained they were listened to and the manager made changes or suggested solutions that people were happy with.
People told us that managers were approachable and listened to their views. The manager of the service, nurses and other senior managers provided good leadership. They ensured that they followed best practice for people living with dementia and associated health problems.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.