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Inspection report

Date of Inspection: 16, 22 September 2014
Date of Publication: 13 January 2015
Inspection Report published 13 January 2015 PDF | 93.56 KB

Overview

Inspection carried out on 16, 22 September 2014

During an inspection in response to concerns

This was the service’s first inspection since the provider’s registration in March 2014. We visited the service on 16 September and 22 September 2014 in response to concerns raised about staffing levels and the lack of leadership within the home as the registered manager and another staff member with specialist knowledge about dementia care had left the service in July 2014. We were concerned about the impact this had on the care provided. As part of our joint working with the local authority and the Clinical Commissioning Group (CCG), we were able to follow up on the concerns raised about people’s safety. The local authority and CCG fund people’s care needs and when people were identified as having continuing health needs the CCG helped to fund this.

There were 38 people using the service, two people were in hospital on the days of the inspection. We spoke with four people who used the service, seven staff and five relatives or friends and three visiting professionals. We spoke to the provider, a senior manager from the organisation, and registered manager from another home owned by the provider. They were all supporting the manager. There was no registered manager in post at the time of the inspection. A registered manager is a person who has responsibility with the Care Quality Commission (CQC) to manage the service and has legal responsibility for meeting the requirements of the law: as does the provider. However a new manager was appointed into a management position. They told us they had no previous experience of managing a care service and received support through other managers.

During our inspection we wanted to understand people’s experience of the service they were using. We did this by spending time sitting and talking with people. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. SOFI allowed us to observe the care experiences of people who had communication difficulties. SOFI was used in the communal setting of the dining rooms. We observed the way staff responded to people. We read three care records about people’s care and spoke with staff about people’s needs.

The evidence we collected helped us to answer five key questions;

Below is a summary of what we found.

Is the service safe?

People we spoke with told us that they felt safe living at the home. We saw that staff were able to meet people’s basic needs but there were times when they were not available to provide extra support to people. Agency staff when available were appointed to provide cover at the home.

Staff told us that they often worked without sufficient staff to maintain cover for the three floors. They told us that they found it difficult to perform their roles safely. This meant people could be placed at risk from receiving care that was not always safe because of inadequate staffing numbers, supervision and support.

Staff recruitment was underway to address staff shortages. However, we found unsafe recruitment practices had taken place historically because relevant safety checks were not always undertaken before staff were employed. The provider told us that adjustments were made to ensure safer practices were followed.

Is the service effective?

We saw that people with capacity to make decisions chose whether they took part in activities. We found from reviewing some people’s care records, their rights were protected because meetings had been held to determine that actions taken were in people’s best interests. Deprivation of Liberty Safeguard (DoLS) applications had been made to ensure people’s rights were appropriately protected. This is where a person is restricted of their freedom and considerations are made in the person's best interest.

We saw that people received a diet that was varied, nutritional and prepared so that they could eat it safely. We saw improvements could be made to the management of meal times. This could include having more staff available to help serve and assist people at meal times.

Staff received training to enable them to provide care in an effective way and communicated with other professionals including community nurses, chiropodists and doctors when people were unwell. Care records and assessments were in place and were kept under review. Regular staff understood people’s support needs and people were asked for their consent to care.

Is the service caring?

People told us that they received care provided by staff that were kind to them and knew their individual needs well.

Is the service responsive?

People and their family representatives were provided with an opportunity to attend and share their views at regular meetings where they were able to comment on the care received. They told us they were listened to and actions were taken to address their comments. Concerns and complaints were taken seriously and investigated.

Is the service well led?

People were positive about their life at the home. They told us the staff were helpful and the nurses were approachable.

A registered manager was not in post. However, a manager was in post and they were supported by the management team. This was because the manager did not have the knowledge and relevant experience for managing a care home with nursing. The provider told us that managers were supported for up to three weeks and further time was given to support this new manager.

Staff did not always feel supported by the management team and did not always feel confident to report their concerns directly to them. We found that the management team needed more time to improve and build relationships with the staff team.

Quality assurance systems meant that people’s views and those acting on their behalf were obtained and acted on. Although, checks were made by the provider for the quality of the service, people were not always protected from some of the risks associated with regular staff shortages. This could have an adverse impact on the care people received.