The home had two areas; one mainly for people with nursing needs and a dementia unit, called The Garden Suite for up to ten people. Both areas had a lounge and a dining room and there was a conservatory off the dining room in the main part of the home.
The inspection team was made up of an inspector, a pharmacy inspector, a specialist nurse advisor for dementia care and an expert by experience. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
People told us they felt safe. We saw there were up to date evidenced based policies and procedures to support staff to keep people safe such safeguarding and Deprivation of Liberty Safeguards (DoLS).
We saw one person had a standard authorisation for a Deprivation of Liberty Safeguards (DoLS) in place. This meant staff could lawfully deprive this person of their liberty because it was in the person's own best interest to keep them safe from harm.
Staff told us they had adequate equipment to safely move and handle people. However, we saw hoist slings were not allocated for individual use. This was putting people at risk of harm of cross infection.
We looked at the recruitment of new staff. This showed that the required recruitment checks into qualifications and experience were in place. This meant people were being supported by staff with the appropriate skills.
We saw there was a system in place to ensure that equipment was maintained and repaired by the maintenance person or an appropriate external service.
Is the service effective?
We looked at four care files. The care files we looked at showed risk assessments for areas such as medication, nutrition, falls and safe moving and handling had been undertaken before care had been planned. Most care plans reflected people's care needs identified in the assessments.
We saw where people had a diagnosis of dementia, mental capacity assessments had not always been undertaken. We saw initial assessments recorded this needed to be done but there was no evidence of a mental capacity assessment in their care files.
Is the service caring?
We saw people were not always treated with dignity and respect by staff. We observed some people were not involved in discussion about their care. For example, we observed one person being transferred by hoist from their wheelchair to an armchair by two care staff. Care staff did not speak with the person other than to ask them to sit forward when they were placing the hoist sling behind their back and again when they removed the hoist sling. Care staff did not ask the person if this was okay with them, explain what they were going to do or ask if they felt comfortable and safe in the hoist. Throughout this procedure the staff talked to each other in loud voices about their duty rota and their personal life to the exclusion of the person.
We observed lunchtime. We saw one person being assisted by two care staff to sit at the dining room table. We heard one member of care staff say, 'Don't put your bum down yet sweetheart.' We heard another member of care staff say to their colleagues, 'Soft ones first.' We were told they were referring to the type of diet some people had, such as soft or pureed food.
We also observed other care staff who did involve people in discussions about their care and gave them a choice. They spoke positively with them giving them encouragement and support to maintain their independence. We heard staff make positive comments to people about their appearance or ask after their wellbeing. A senior carer told us some staff were better at involving people in their care than others.
Is the service responsive?
We saw that people's individual physical, mental and social care and support needs were assessed but not always met. We saw people were not always given a choice of how they wished to spend their day.
Some people told us they had to remain upstairs in their bedrooms until the care staff were free to look after them downstairs. One person told us, 'This is my home; I'm waiting to be taken downstairs.' The manager told us because there was no dining room or lounge upstairs people took their breakfast in their bedroom. The registered bank nurse told us, 'When it's safe they can go downstairs.' This meant people were not free to move about the home as they wished.
We saw a copy of the annual customer satisfaction survey for 2013. 37 forms were sent to relatives and 13 were returned. 82% of people who responded were positive about the staff. One of the feedback comments read, 'Higher staffing levels and a permanent manager.' We saw the evidence on our visit this feedback had been actioned.
The manager showed us how regular checks are carried out to identify any problems with the safe handling of medicines in the home and the actions that had been taken to prevent them happening again. The last check had been carried out just before our inspection and had identified many but not all of the issues that we found.
Is the service well-led?
We saw recruitment practice was safe and thorough and all the required checks had been carried out before staff commenced their employment. A recently appointed member of bank staff told us all the staff and the manager had been supportive
All the staff we spoke with told us there were enough staff in the home to deliver care to people. The bank registered nurse on duty said, 'There is enough staff on duty today. They are looking for more staff.' The Head of Care told us, 'There are enough staff, it has improved recently.' A bank carer told us, 'There are enough staff, allocations all get done.' However, they did acknowledge at times care was delivered in a task focussed way. They also told us, 'The manager has been the nurse in charge, she mucks in.'