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Inspection report

Date of Inspection: 23 April 2014
Date of Publication: 24 May 2014
Inspection Report published 24 May 2014 PDF


Inspection carried out on 23 April 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. Some people using the service had complex needs which meant they were not always able to tell us their experiences. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Care records and risk assessments identified the support people needed to keep them safe. People we spoke with confirmed their care plans were an accurate reflection of the care they needed and received. Other health and social care professionals were contacted for advice when needed. The provider was the financial appointee for five people living at the home. Records were kept of transactions and these were audited to identify potential financial abuse.

The safeguarding policy shown to us was a generic policy from an external company that had not yet been adapted to reflect the practices of this care home. The provider told us they would adapt the policy following our visit but we have not yet checked this has been completed.

Staff had received training about safeguarding and the Mental Capacity Act 2005 and knew what to do as a result of a safeguarding concern. People we spoke with told us they would tell staff if they were unhappy or felt unsafe. Care staff knew how to recognise someone being deprived of their liberty and actions to take as a result. There were no restrictions in place at the time of our inspection. We saw information about safeguarding and the Deprivation of Liberty Safeguards (DoLS) available to people in an easy to read format.

Medicines were stored, administered and recorded safely. We did, however, find some liquid homely remedies were not being dated on opening and some medicines were not counted each month to check the number of tablets being carried over. We also found two �as required� medicines had not been destroyed when they were no longer needed. The provider told us they would address these issues following our inspection. We have not yet checked this has been done.

Staff received appropriate medicines training and their competency to administer medicines was assessed before they administered independently. Although there were two medicines policies available at the home neither was an accurate reflection of the procedures in place. The provider told us they would adapt one of the policies to reflect the procedures in place at the home. We have not yet checked this has been completed.

Is the service effective?

People�s health and care needs were assessed. This involved the person where possible. Staff were aware of changes in people's needs and shared these with colleagues. We did, however, find that some relevant information recorded elsewhere in people�s care records, such as notes from medical appointments, had not been included in their detailed care plans. We also found there was limited information on the support people needed to communicate or if they became anxious. Staff we spoke with had a detailed understanding of people�s behavioural and communication needs.

Staff told us they encouraged people to be independent and to complete everyday tasks themselves as far as possible. Staff discussed people�s progress with them at client meetings and updated each other at staff meetings. We observed staff taking the time to allow people to do things independently and often heard staff asking people if they would like to help with tasks around the home.

People were supported to eat and drink sufficient amounts to meet their needs. Their dietary requirements were recorded in their care plans to ensure staff knew how to support them. People had their weight monitored regularly to ensure they maintained a healthy weight. Staff also used weight changes to identify if someone was unwell or unhappy. People were provided with a choice of suitable and nutritious food and drink. Staff explained to us how they supported people to eat the food they needed and preferred.

Is the service caring?

People�s preferences, interests, wishes and diverse needs were noted in their care records. Staff spoken with had a good understanding of how people wished to be supported and provided care in accordance with their wishes. All the interactions we observed between people and staff were patient, caring and professional. People clearly enjoyed the relationship they had with staff.

Feedback from people included, �Staff are good. I like it here� and �I am happy here. Everything is nice. Staff are nice.� We spoke with two relatives. One told us they were �more than happy� with the care provided. They told us their relative was very happy and �had a better social life than [them]�. Another relative commented on the positive family environment at the home.

Staff had worked with people to identify their cultural and religious preferences. They then sought to meet these preferences. The home had also worked sensitively to identify people�s sexual needs and provide appropriate support. Each person had an end of life care plan which contained detailed information important to the person and was in an easy to read format. People and their relatives had been involved in putting the information together which was sensitively written.

Is the service responsive?

As people�s needs changed the service adapted to accommodate them. Other health and social care professionals were involved when needed to assess people�s needs and provide guidance and support. A professional who visited the home regularly told us people seemed �very well cared for� and said staff informed them promptly if they were worried about someone.

Is the service well led?

A quality assurance system was in place which included gaining the views of people who lived in the home. A satisfaction survey was completed in February 2014 and all of the responses showed the home as excellent or good. Some of the comments received included, �All of them are very nice� and �It�s the best, I like it here�. People were also listened to via �client meetings� and using complaints.

The relatives we spoke with told us they could raise a concern if they needed to. One comment had been shared by a relative and this had been appropriately addressed. Staff told us they felt listened to and well supported.

Audits were in place to monitor the safety of the environment people lived in. This included cleanliness monitoring and annual health and safety checks. Staff told us maintenance requests were dealt with in a timely fashion to keep people safe. We did not see evidence of unaddressed maintenance work. The administration of medicines was audited although we found the audits did not look at the dating of creams, drops and liquids on opening, the disposal of expired medicines or the balance of tablets not in the monitored dosage system. Checking these issues could protect people from medicines errors.