This was an unannounced inspection carried out on 2 February 2016.Hillside provides a service for older people and some of whom have a diagnosis of Dementia. The service is over two floors. At the time of the inspection there were 37 people living at the service.
The service had a registered manager. 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 2014 and associated Regulations about how the service is run.
This was a comprehensive inspection to look at how the provider was meeting regulations relating to the fundamental standards of care.
People and staff felt there were not always enough staff deployed in the service.
Although the service used a dependency tool, we did not consider that the needs of the people using the service were being accurately recorded, in particular more people were requiring high needs care that medium as recorded. The registered manager and area manager did re-assesses everyone using the service as a result of our inspection and did change four people from medium to high care, but this did not require according to the tool an increase in staff on duty. This meant that the service was understaffed.
Some people made complimentary comments about the service they received. People told us they felt safe and well looked after. Our own observations showed that the staff were very caring, however the records we looked at did not always match our observation and the positive descriptions people had given us.
The planning of care for people included people’s physical, emotional, spiritual, mental, social and recreational needs. There was information about people’s likes and dislikes.
Staff did not always feel well supported by the provider and the management team. The staff training records showed that not all staff had received necessary training to make sure they have the skills and knowledge required to care for all people’s specific needs. Refresher training had also not been provided in a timely way or staff felt that the e-learning training was not sufficient.
Staff supervision had not been arranged on a regular basis. However the manager did provide on the spot informal supervision and support to staff. A new supervision process was being set up so that the manager would not supervisor all staff and this would be appropriately delegated to other senior staff. The manager told us that each member of staff was to have an annual appraisal to assess their performance and any further training needs.
People were complimentary about the food and were provided with enough to eat and drink. Choices of menu were offered each day.
There was a system for managing complaints about the service. People and their families were listened to and knew who to talk to if they were unhappy about any aspect of the service. The complaints policy was on the notice board. We also found that complaints had been listened to and actioned.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some people were assessed as lacking capacity to make decisions for themselves at this service. Staff were supporting people following decisions they had made which were in their best interest. Not all staff felt confident in the training they had received training in the Mental Capacity Act 2015 or DoLS. The manager was knowledgeable in this area and had applied DoLS and Best Interest meetings appropriately.
Staff were kind and caring in their approach and had a good rapport with people. The atmosphere in the service on the day of our inspection was calm and relaxed. Some people did exhibit challenging behaviour on occasion due to their health condition and we saw that this was recorded and information provided in the care plan of what staff were to do in such circumstances. However talking with staff we drew the conclusion that they had not received sufficient training to deal with people’s behaviours and conditions or the training had not provided them with the depth of knowledge or confidence they were seeking.
Safe recruitment procedures were followed to make sure staff were suitable to work with the people at the home and there were processes in place designed to safeguard people from abuse.
People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and were complimentary about the care their relatives received.
During this inspection, we found a breach of regulation relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report