We (the Care Quality Commission) carried out an unannounced visit to Choice on 07 August 2012.The home was last visited by the Commission for Social Care Inspection (the predecessor organisation of the Care Quality Commission) in March 2009.
During our visit we spoke with the manager, three staff and one person who lived at the home in private.
Not everyone was able to tell us what it was like living at the home as most people had a dementia type illness. Therefore, we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences of living at the home were like. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 20 minutes observing people sitting in the communal lounge and found that people had mixed experiences.
We looked at the care files for five of the people who lived in the home. We saw that four contained detailed care plans that set out the individuals' needs. The files were clear about the level of support people needed and what they could manage on their own. There was also some information about people's backgrounds which meant that staff were aware of events in people's lives that could impact on the care they provided. The fifth file contained a detailed pre admission assessment but there was no care plan completed as this person had only recently been admitted and the information had not been gathered.
We saw some evidence that people or their representatives had been involved in completing their care plans. This meant that people could contribute and have their say about how they were supported. The care plans were comprehensive and gave good directions to staff. However, the provider may wish to note that much of the information was repeated.
While we were in the lounge some people were watching the TV while others were chatting. This caused some argument as those who were watching TV were interrupted by those chatting. Whilst staff did try to intervene in the actual argument there was no attempt by them to remedy the matter. This meant that the argument rumbled on with no one being entirely satisfied. The provider may wish to note that people's care and treatment did not reflect relevant research and guidance for people with a dementia type illness. We know this because staff did not distract people or engage them in meaningful attempts to stop the argument.
We saw positive interactions between staff and individuals. Staff offered people a choice of drinks and gave comfort to people who became distressed during the argument.
Staff that we spoke with told us that the home had a policy relating to safeguarding people. They were able to tell us about different types of abuse and what they would do if they suspected abuse was occurring. However, the provider may wish to note that staff had not received any formal training in safeguarding people.
People that we spoke with praised all the staff who worked at the home. One person told us "Staff are wonderful ' I'm very happy with the help they give me". They also said "I feel very lucky to have come here".
Staff told us that they felt there were not enough staff on duty to provide social activities and engagement for people. They said that people's personal care needs were being met, but this was sometimes because staff did not take a break during their shift. The manager told us that six or seven people needed two care staff to help them with their personal care and that "pretty much everyone" had a certain level of a dementia type illness. The manager said that they felt an extra member of staff was needed in order to fully meet people's needs. They told us that the providers were looking to improve the situation.
Generally the home was clean, tidy and comfortable. However, the manager told us that there had been no investment into the home for some time and this meant that many areas were in need of refurbishment. We saw areas that were in need of redecoration where paintwork had been chipped and scuffed. Carpets and wallpaper were highly patterned. The provider may wish to note that highly patterned furnishings are not recommended for people who have a dementia type illness as the patterns can affect people's perception and cause an increase in their confusion.
The manager told us that people who lived at the home were not regularly consulted about the quality of care provided, but that they were hoping to introduce a system that enabled their views to be obtained.