You are here

All reports

Inspection report

Date of Inspection: 28 July 2014
Date of Publication: 3 September 2014
Inspection Report published 03 September 2014 PDF | 87.98 KB

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)

Meeting this standard

We checked that people who use this service

  • Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 28 July 2014, talked with people who use the service and talked with carers and / or family members. We talked with staff and reviewed information given to us by the provider.

Our judgement

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

Reasons for our judgement

We saw quality assurance documentation which showed us there was a programme of audits completed throughout the year to monitor the quality of care provided. This included checks of; finances, care files, medication, accidents and incidents, the environment and various health and safety checks. The clinical services manager also visited the home on a weekly basis and completed a detailed audit of the service every two months. This audit looked at all areas of the home including staffing levels, recruitment, care plans and the environment. We saw their last audit completed in June 2014 had identified areas for improvement in relation to some care plans. The manager had developed an action plan which detailed how they would address the issues raised and the clinical services manager had returned to the home on the day of our inspection to check appropriate improvements had been made.

The deputy manager explained they monitored accidents and incidents on a daily basis and when necessary took action to reduce the risk to the individuals concerned, such as making appropriate referrals to health professionals. They reviewed each incident which enabled them to look for any trends or patterns and identify actions to reduce the risk of similar events happening again.

Regular meetings were held for people who used the service and each person had a monthly meeting with their key worker which provided people with the opportunity to say what was going well for them and identify where improvements were required. The deputy manager explained that where people were unable to communicate their preferences through speaking, staff would use pictures to establish how people felt about the care and support they received. They also involved people’s relatives and residents by inviting them to six monthly care reviews. The relatives we spoke with confirmed this. We checked the minutes from the service user meeting in March 2014 and saw a wide range of issues was discussed including meals, social events, complaints and safeguarding. This showed us that people were provided with the opportunity to be involved in how the service operated.