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Inspection report

Date of Inspection: 3 October 2012
Date of Publication: 31 October 2012
Inspection Report published 31 October 2012 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 3 October 2012, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service and talked with staff.

Our judgement

People experienced care, treatment and support that met their needs and protected their rights.

Reasons for our judgement

During our visit to the service in May 2011, we found the risk assessment process was not always effective in ensuring people were kept safe. Following that visit the registered manager sent us an action plan detailing the actions they had taken to become compliant. On this visit to the service we found that the action plan had been implemented and was effective. The registered manager had reviewed the risk assessment process. Risk assessments now capture the actions staff have taken to minimise the risk of falls and incidents of challenging behaviour. We found that both types of incidents were regularly reviewed at care meetings and at management meetings. This meant that care and support was planned and delivered in a way that ensured people’s safety and welfare.

In the care plans we looked at we saw that the registered manager or senior care staff had conducted risk assessments for people’s mobility, nutrition and communication, for example. The risk assessments were used to create person centred care plans, which people, or their relatives, had signed. We found that the plans were detailed with clear instructions for staff to follow. Care staff we spoke with had a clear understanding of people’s abilities and dependencies. One care staff told us, “It all depends on how the person is and what works with them.”

One member of care staff told us, “X has a memory book to remind them of things. I don’t tell them difficult facts, but point them to ‘read the book’ and then we can talk about it” and “Y forgets, they don’t settle. They need one-to-one attention most of the time. You learn everyday.” This meant that people’s needs were assessed and care and support was planned and delivered in line with their individual care plan.

We saw that staff weighed people very month and noted when people lost or gained weight as a check that their health was maintained. The registered manager told us that a local GP used to call regularly at the home and would check people’s recorded weights, but this service was no longer available to them.

The registered manager told us they were planning to put a new protocol in place. The protocol would include advice for care staff about each individual’s optimum body mass index score (BMI) and the actions staff should take if that was not maintained. The registered manager told us about actions they had already taken for some people who were observed to have lost their concentration for eating regularly. For example, full fat meals had been implemented for one person, one person had moved to a different seat in the dining room, where there were fewer distractions, and a dietician had recommended additional ‘finger foods’ for another person. This meant that care and treatment was planned and delivered in a way that ensured people’s safety and welfare.