We spoke with eight of the 15 people living at the home and eight visitors. We also spoke with the registered manager and staff. We observed care in communal areas and viewed records relating to care, staffing and the management of the home.We considered seven outcomes during this inspection. These being
Outcome 4 Care and welfare of people who use services
Outcome 7 Safeguarding people who use services from abuse
Outcome 10 Safety and suitability of premises
Outcome 12 Requirements relating to workers
Outcome 14 Supporting workers
Outcome 16 Assessing and monitoring the quality of the service
Outcome 20 Notification of other incidents
We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.
Is the service safe?
People told us they were happy with the service they received. They said they felt safe and had the same staff who knew how to help them. One visitor said, 'I visit as often as I can and (my relative) always seems clean and well cared for. I have no worries about them when I'm not here'. Although all staff had not completed specific safeguarding training they were able to tell us what they would do if they had any concerns about people's safety or welfare.
Systems were in place to deal with emergencies that could be predicted to happen. Staff had acted promptly to seek medical advice when a person had been injured following a fall. Equipment was in place to alert staff to vulnerable people who may be moving around their bedrooms and at risk of falling.
We found the home had not completed individual mental capacity assessments before allowing others, such as relatives, to make decisions on behalf of people. Otherwise, we found the home to be meeting the requirements of the Deprivation of Liberty Safeguards.
We found the home did not have full information about all staff to demonstrate they were suitable people to work with vulnerable adults. All staff had not completed all necessary training. This was especially linked to apprentices working in the home. They had been placed there by a training provider, but were now working as full members of the staff team.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring they have all necessary information about all staff and that all staff have completed all essential training.
Is the service effective?
Not all aspects of the service were effective. People were receiving a service which met their needs. The manager and staff were knowledgeable about people's care needs and how to meet them. However, care plans and risk assessments had not been updated to reflect changes in people's needs. The manager and staff were aware of who to contact for specialist advice and when this may be required. We saw where necessary external health professionals were appropriately contacted. Records of care showed people had received care. We spoke with a visiting external health professional who said people's needs were met and staff were available to support them when they visited the home.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring care records and risk assessments accurately reflect people's current needs.
Is the service caring?
People were supported by kind and attentive staff. People said they were treated with respect and dignity by the care staff. People also told us they were happy with the way they were supported. People said they were happy living at the home. One said 'I am very happy; the staff are wonderful and so helpful'. Another person told us 'I came in for a short stay after coming out of hospital. I went home and soon decided to return as I felt it was the best thing to do. I have not regretted my decision'.
Staff said they had time to meet people's needs and could provide the care people needed. Staff were aware of people's rights and respected these.
Is the service responsive?
Procedures were in place to manage unexpected events which could interrupt the smooth running of the service. Senior staff were aware of what they should do in the event of an emergency. Fire detection equipment was checked regularly and action had been taken to address improvements required following an external health and safety audit.
Where we identified missing information or concerns during the inspection the manager acted promptly. For example, we identified that there was no evidence that a person who was on bed rest was receiving regular changes of position. During the inspection the manager devised a turning record form and put this into use.
Is the service well-led?
The provider is a limited company with two directors. Both directors were actively involved in the running of the home and spent three days per week there. One was the registered manager. In the four months they have owned the home they have identified and initiated improvements to the environment including redecoration of bedrooms. However, audits of care records, including medication administration records, were not being completed. Records did not always accurately reflect the way people's care needs should be met especially where people's needs had changed. Staff meetings had been held monthly to keep staff informed of any changes and remind them of procedures. The manager had contracted with external organisations to provide training for staff and to provide staff management support should this be required.
We identified that we had not been notified about all incidents which the registered person was required to inform us about.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring we are informed about all notifiable incidents and how they intend to monitor the quality of the service provided.