27 October 2015
During a routine inspection
This inspection took place on 27 October 2015 and was an unannounced comprehensive inspection.
The last inspection took place on 7 August 2014. There were no breaches of the legal requirements however the service was given a rating of Requires Improvement due to some areas of concern regarding the deployment of staff and the condition of the premises. At this inspection we found the service had sufficient numbers of staff to meet people’s needs, although there was a regularly occurring issue with some staff repeatedly taking short notice sickness absence at weekends which was putting pressure on the staff team. The service had taken action to improve the condition of the premises which been re-carpeted and redecorated. There were new furnishings due to arrive at the service in the coming weeks.
The service is a care home which provides nursing care and support for up to 26 predominantly older people. At the time of the inspection there were 22 people living at the service. Some of these people were living with dementia. The building is a detached house over three levels. Stairs in the service had stair lifts to support people, with mobility problems, to access all areas of the service. A passenger lift was planned to be installed in the coming months.
The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We walked around the service which was clean and comfortable and bedrooms were personalised to reflect people’s individual tastes. People were cared for by staff who were kind and patient. People’s dignity was not always respected as people were required to share slings, used for moving and handling. This was also a potential infection control risk. The registered manager told us they had enough slings to be able to allocate the correct size sling to a person for their sole use and this would be done immediately.
We looked at how medicines were managed and administered. There were some gaps in the medicine administration records, where staff had not signed to show if people had received their medicine as prescribed. Regular medicines audits were carried out and where gaps were noticed in records, staff were reminded of the importance of recording. Medicines that required stricter controls were managed safely. Nurses monitored when people had their prescribed creams applied.
Risks were identified and assessed. There was detailed information for staff on how to reduce risks. However, some information required updating to accurately reflect the current situation for some people.
The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The morale of the staff was low. The short notice absences of staff at weekends, put staff under pressure to cover the workload and increased stress levels. The service was finding the recruitment of new nurses to fill vacant posts challenging.
New staff were supported by a system of induction. Training was provided, monitored and updated appropriately. More specialised training specific to the needs of people using the service was being provided such as dementia care. Some supervision was being provided to some staff. Staff told us they felt well supported by the registered manager who was always available to them if needed. Staff had not received appraisals.
Staff meetings were held. These allowed staff to air any concerns or suggestions they had regarding the running of the service. Some catering staff felt they were not part of the staff team and did not attend all care staff meetings. The registered manager told us the service held separate meetings for nurses and care staff. There were combined meetings held to which all staff were invited.
Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.
Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.
Activities were provided during the week. There was a varied programme of planned activities and people were involved in events such as a planned Bonfire Party and preparations for Christmas festivities. People’s views were sought at residents meetings and action taken in response to issues raised.
The registered manager was supported by a team of nurses. There was not a deputy manager but an area manager supported the registered manager on a regular basis. The service was well maintained. A system of quality control audits ensured the registered manager was aware of all aspects of the service provision, that may need addressing and strived to continuously improve it.