Archived: Notintone House

This is a summary of what we found-

Is the service safe?

During our inspection we found there were some practices that promoted people's safety, however we also found some areas where this could be improved.

We saw risk assessments completed to identify any risks people faced through the activities of daily living, but we found a lack of clarity about which people required pressure reliving equipment and where some people did, there was no record in their care plan that this had been provided.

We found there were suitable arrangements in place to manage the safe storage, handling and administration of medicines. A person who preferred to spend their time in their bedroom told us, 'Staff come here to give me my tablets. They never forget me.'

There were sufficient care workers to respond to people's health and welfare needs. A person who used the service told us, 'The staff are very good, they know what they are doing. We have the right kind of staff.'

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found staff were effective at respecting and involving people who used the service. A person who used the service told us, 'The routines of the home are in our interest.' Another person said, 'They always listen to what we say.'

We saw people received food that was appropriate for their needs and culture, and where needed people were given assistance to eat their meal. However we found nutritional monitoring charts were not used correctly, which increased the risk people faced of malnutrition.

Staff said there had been improvements in the staffing arrangements and they now had the number of staff they needed to meet people's needs. A person who used the service told us, 'I would say there are enough staff.'

Is the service caring?

We found staff were sympathetic and caring. We saw staff were attentive and respectful when speaking with or supporting people. One person who told us they were frightened when they moved to the home said, 'The staff have made me comfortable.' Another person said, 'Staff handle residents who can be difficult well. They show the upmost kindness.'

Is the service responsive?

People who used the service felt their needs were responded to. One person told us, 'I was really poorly when I came here, they have really sorted me out.' We found the service did not respond well to people's changing needs by reviewing and updating their care plans. Information that was passed onto staff coming on duty at handover was not written in the person's care plan.

Is the service well-led?

We asked a person if they thought the home was well led. They told us, 'It is well led, the managers are wonderful, so are the team leaders.'

There had been four new team leaders employed who were described by the head of care as working well together and, 'Encouraging to staff.' Staff said they felt things were better managed than previously. A person who used the service told us, 'The staff are very good, they know what they are doing. We have the right kind of staff.'

There were quality assurance systems in place to help identify any improvements that could be made. There were systems to gather the views of staff and people who used the service. A staff member said, 'I feel listened to now. I think the residents are listened to as well.'

Prior to our visit we reviewed all the information we had received from the provider, including an action plan detailing how they would comply with the compliance actions we set at the previous inspection. During the visit we spoke with five care staff, two team leaders and the head of care. We looked at some of the records held in the service. We spoke with three people who used the service but they did not have any comments to make on the outcomes we inspected.

We found the provider had made some of the improvements we required to become complaint, but found improvement was still needed in 'Management of medicines.'

We inspected the outcome, 'Staffing' as we received some concerns about this. We found there were insufficient qualified, skilled and experienced staff to meet people's needs. A team leader said, 'We manage when there are five staff on, but people aren't here to be managed, they are here to be cared for."

We spoke with six people using the service and received positive feedback about the care in the home, including, 'staff treat me with respect and observe my dignity. The care I receive is pretty good', 'If I need to see a doctor or visit the hospital the staff will arrange the appointments for me.'

People were protected from abuse or the risk of abuse. Staff were aware of their responsibility to report poor practice and knew the processes for reporting incidents. People we spoke with told us they felt safe in the home with one person saying, 'I've never had any problem at all with staff and I trust them to help me if I had any concerns. I feel safe here'

Medication was administered safely to people. However records were not always completed to show staff had applied external preparations such as creams and ointments as prescribed by people's GP. Medication was not being stored safely.

People were supported to have their say in how the service was run. There were audits being carried out to monitor the quality of the service. However the audits were not always effective in identifying issues where improvements were needed.

People told us they were happy with the care they were receiving from staff. However, people's needs were not always fully assessed and planned for in accordance with their current needs. Of the three care plans we saw, all of them contained information which did not reflect the needs of the person.

People told us they felt safe in the home and we saw staff recognised abuse of vulnerable adults and knew how to respond to incidents or allegations.

We saw that safe recruitment procedures were being followed in the home, to ensure staff employed were suitable to work with vulnerable adults. We spoke with four people using the service about the staff and they all gave positive comments. One person said, 'They are very caring and know what they are doing.' Another person said, 'The staff are wonderful, I am very happy here.'

People we spoke with told us they would feel comfortable raising issues with the manager or staff and felt confident that any complaint would be dealt with.