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Inspection report

Date of Inspection: 1 May 2014
Date of Publication: 28 June 2014
Inspection Report published 28 June 2014 PDF


Inspection carried out on 1 May 2014

During a routine inspection

We inspected the service on the 1 May 2014 to follow up areas of concern identified at a previous inspection on the 9 October 2013. During this inspection we were met by the manager who was not yet registered with the Care Quality Commission as they were new in post. We also met the Area Manager who was also new to the role.

During our inspection we spoke with 14 people who used the service, three relatives, six staff members and observed the care on both the ground and first floor. We looked at six care plans and other associated care records. We also looked at staffing records quality audits and health and safety records. We considered our inspection findings to answer 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?

This is the summary of what we found:

Is the service safe?

The entrance of the building was secure and staff checked our identity. People were free to move about but a key code system gave people additional security. We saw that a number of people had door sensors which would alert staff as to when people were mobile and at an increased risk of falls. We saw that call bells were in people�s reach and answered promptly by staff. People received adequate supervision from staff and records showed us people were regularly checked to ensure they were safe. We saw that staff worked closely with the falls prevention coordinator and records showed very few recorded falls in the last few months which meant the staff were taking necessary action to keep people safe.

Staff had received training in safeguarding vulnerable adults from abuse and the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff were provided with the information that they needed to recognise and report concerns so that people were protected from abuse as far as possible.

The environment was well maintained and we saw a schedule of maintenance which ensured equipment was in good working order and fit for purpose. Staff were employed in sufficient numbers to ensure the building was hygienic and the risk of infection was kept at a minimum. We observed staff wearing personal protective clothing as appropriate and we saw daily, weekly and monthly cleaning schedules were in place. We noted one carpet which needed replacing urgently because of a strong smell of urine. We told the manager about this.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that the records had been reviewed and updated. This meant that staff were provided with up to date information about how people's needs were to be met.

We saw that staffing levels were being maintained in accordance with people�s assessed needs which meant staff were able to meet people�s needs. However the service was failing to meet people�s social needs. The activities person had left in February 2014 and had yet to be replaced. This left people with little or no opportunities to have support to engage in social activities and hobbies?

Is the service caring?

The interactions we observed by staff were kind and we found staff responded appropriately to people�s requests and needs. We spoke with some relatives, one told us, and �The staff are smashing.� Another said, �My family member�s needs are met by staff.�

Is the service responsive?

We saw call bells were answered quickly and people�s needs were responded to quickly. We observed lunch and saw that most people received the support they needed in a timely way and staff did not outpace people when supporting them with their meals. The staff team appeared relaxed and frequently interacted with people, even when just passing through communal lounges they would stop and acknowledge people in an appropriate manner.

People were supported to see other professionals such as general practitioner, community dentist, chiropodist, optician, and district nurse. This showed that people�s general health care needs were considered and that the service was responsive to people�s changing needs.

Is the service well led?

The service was fully staffed and staff told us that staff sickness and shift vacancies were managed well? The manager would use bank staff to cover shifts but we were concerned that the manager was also covering shifts which meant that they had not had the time to implement some of the changes they wanted to introduce to improve the service.

The manager was ensuring that staff were appropriately supported throughout their shift and was in the process of ensuring they received regular supervision of their practice and annual appraisals. We saw evidence that not all staff had received a recent supervision which meant we could not be assured that all staff were properly supported.

There were regular audits of the quality of the service and audits on the care provided to people. This meant there were systems in place to identify where the service was meeting regulation and where it needed to improve. We saw that audits took place across the day and night shift which enabled the manager to see the service provided over a 24 hour period. We saw poor consultation with people using the service. The annual questionnaire sent out to people and, or their families had a very low response rate of 4% and we could not see what others ways the service were actively engaging people or seeking their views about the service. The provider told us they planned to hold resident/relatives meetings every other month but no meetings had been held in recent months and there were no planned forthcoming dates. The manager told us six monthly reviews would be held to review people�s needs but we did not see a schedule of planned reviews or evidence of six monthly reviews in people�s care plans.