We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?
The inspection was completed by two inspectors. We spoke with eight people living in the home and seven members of staff. This is a summary of what we found.
Is the service safe?
People said, 'Staff look after me very well', 'Staff treat me well', 'I am amazed at the kindness of staff'.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.
On the whole there were enough staff on duty to meet the needs of people living at the home and a member of the management team was available on call in case of emergencies. At times staff felt additional support would be beneficial.
The medicines were not being managed so that people received them safely. Appropriate arrangements for the safe keeping, safe administration and management of medicines were not in place. This meant people were not being protected against the risks associated with the unsafe handling and management of medicines. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.
Monitoring of accidents and incidents was not robust. Trends were not responded to quickly enough to prevent further harm to people. Quality assurance audits highlighted actions to be taken to address any shortfalls but these were not being properly monitored or acted upon to make sure the changes were made. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the assessing and monitoring of the quality of service provision.
Is the service effective?
People were supported to be involved in the assessment of their needs. Their individual needs, choices and preferences were reflected in their care records. For people living with dementia their reactions to pain had been assessed. This meant staff were able to recognise when people living with dementia were distressed due to pain and able to take the appropriate action. Where people were at risk of falls they had been provided with equipment to minimise the risk of injury. People were supported to make arrangements for the end of their life reflecting their preferences and wishes.
Staff were not having support to take part in learning and development to make sure they were competent to carry out their role. Staff were not receiving the opportunities they needed to keep their skills and knowledge up to date. This meant staff were not being properly supported to provide care and support to people who lived in the home. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff to receive appropriate training and professional development.
Is the service caring?
We observed staff treating people respectfully, sensitively and with shared humour. A visitor said, "Staff speak to her as a person. They are patient and lovely." Staff had a good understanding of people's needs. They were attentive and noted when people needed help or support. If people were observed not eating their meal they were offered an alternative.
A person told us, "I chose this home. My wife is able to visit me daily." Another person said, "Very lucky to be here". People told us they discussed their views about the home at resident's meetings. One person told us, "We have residents' meetings. Everything we ask for they have arranged by the next day."
Is the service responsive?
People's preferences, interests and diverse needs were recorded and we saw that their care was provided in accordance with their wishes. Activities were provided such as bingo, music, trips out and the home's cinema. Visitors were welcomed and people could meet with them in privacy if they wished.
People said they were able to give feedback about the service provided. A person told us they had asked for fresh fruit to be served at mealtimes. They said this was provided the following day. A visitor said, "The managers are approachable and I would talk to them if I had any concerns. I have none." People living in the home said they had no complaints.
There was a lack of consistency in the way people's changing needs were reflected in their care records. For some people this meant an inaccurate or incomplete record was being kept which could potentially lead to the incorrect care being provided. Some records were not being kept securely promoting people's right to confidentiality. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the maintenance of accurate records for people.
Is the service well led?
People had completed surveys as part of the annual quality assurance process. This resulted in improvements to the service such as a review of housekeeping and the laundry system. Visitors, other professionals and staff had also completed surveys to express their views about the service provided.
A range of quality assurance checks were in place to make sure the home was operating safely. Health and safety audits were completed at appropriate intervals. The provider had recognised the need to improve their quality assurance visits to the service. Their audits would be more frequent and look at the service as a whole rather than at individual areas such as care planning or medicines.
There was evidence the way the service was managed did not always anticipate risks and they did not have strategies to minimise them to ensure the smooth running of the service. This meant that the service was reactive rather than proactive in their response to accidents and incidents. This meant people were not being protected or safeguarded from the risk of further accidents or incidents.