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Inspection report

Date of Inspection: 10 November 2011
Date of Publication: 14 December 2011
Inspection Report published 14 December 2011 PDF

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

Not met 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

Our judgement

People benefit from the support that they receive from staff with their day to day care needs. However, the standard of care planning and a lack of up to date information puts people at risk of not receiving the care that they require.

Overall, we found that improvements were needed to this essential standard.

User experience

We met people who received nursing care in their rooms and had a high level of individual needs. They were dependent on staff for support with their personal care and with keeping safe. Staff told us about the support that people received, for example with pressure area care and with eating and drinking to ensure that they had a sufficient amount. The staff members said these areas were given a high priority and they were aware of the risks to people if they did not receive the right level of support.

We heard positive comments about the support that people received, although not everyone was able to express their views directly. One person told us they received a lot of help with their personal care and staff provided the support they needed. They said that staff helped with cutting finger nails and they saw a chiropodist for their feet. We met relatives who said that they thought their family members were well cared for in the home.

We saw that people had drinks in their rooms to help ensure that fluid intake was maintained during the day. There were no unpleasant odours in the accommodation that we saw. A number of people had wheelchairs and we saw these being used with footplates adjusted so that people were comfortable. The people we saw in the communal rooms looked well supported with their personal appearance. During the morning, some people in the lounge were encouraged to take part in some gentle exercises which were designed to help them with their mobility.

People received end of life care at the home. The staff we spoke with told us they had received training and guidance which helped them to support people and their relatives. We were told that the home was working towards accreditation under the Gold Standards Framework. This is a quality assurance scheme for services that provide end of life care.

People benefited from the involvement of outside health care professionals. Staff said that people received good support from their GPs and from the local health services. We met with a physiotherapist who said they visited the home twice a week. We were told support was also available from an occupational therapist who advised on appropriate aids and equipment for people to use. People received support from specialist nurses in the community, for example the tissue viability nurse, in addition to the home’s own nursing team.

Other evidence

People's care was being recorded in individual files. We looked at five people’s care records, which included a range of assessment and care plan forms, together with charts for recording the care that people received on a day to day basis. The files themselves looked unhygienic. The paper contents were generally in a poor condition, with loose sheets which made it difficult to ensure that the information was kept securely and in order.

A small number of care plans had been audited by the home’s manager and this had identified various shortcomings and improvements that needed to be made. The audit had found that some of the care plans needed to be more personalised, and updated and reviewed. Our findings confirmed that risk assessments and care plans were not being consistently reviewed and updated. There was therefore a risk that people’s care plans did not reflect their current needs.

We saw that a lot of information was being recorded by staff about the care they had provided. This helped to ensure that areas such as pressure area care and fluid intake could be monitored and evaluated. However, the daily reporting was not always being clearly linked to up to date care plans and risk assessments.

Changes to people’s care plans and risk assessments were not always being clearly recorded, which meant that people were at risk of not receiving the care that they needed. We saw care plans and risk assessments that had been written over five years ago; in a number of cases, changes had been made over time by crossing out the original information and writing in some additional and undated comments. This is poor practice which can lead to misunderstandings about people’s current needs and the support that they require from staff.