This inspection was carried out by a CQC inspector. We spoke with four people who used the service, two relatives, two staff members, the registered manager and a health care professional. We also reviewed records relating to the management of the home which included two care records, daily care records, medication records, staff files and training records and minutes of meetings. We used the information to answer the five questions we always ask: Is the service safe?
A robust safeguarding procedure was in place. The provider used imaginative ways of involving people in awareness of safeguarding to ensure they were safe
Recruitment practice is safe and thorough. Staff had appropriate induction and training prior to working with people who used the service. No staff had been subject to disciplinary action. Policies and procedures were in place and available to staff. This ensured good practice and also that people were safe.
Risk assessments were in place for each person for aspects of daily living. Assessments had been reviewed regularly to ensure that staff were aware of any changes in relation to risk and to provide information for staff to be aware of the current risk profile for each person using the service.
We saw people received effective and safe support to take medicines they had been prescribed, because detailed and accurate records were kept and monitored closely by senior staff. Staff received regular competency tests to ensure they continued their level of knowledge and competency to administer medicines.
We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. The service had procedures in place and the manager knew how to apply for this authorisation. We found that applications had been made under DoLS procedures for each of the six people who used the service. The service was waiting for replies from the best interests team of the local authority in relation to their applications.
Is the service effective?
People's health and care needs had been assessed and care records reflected the correct level of support people needed. Referrals to a range of health care professionals had been made. A visiting professional told us the service worked closely with them in providing a coordinated plan of care and treatment.
We saw that the views and comments of people and their relatives were expressed in written reviews and their plans of care had been updated.
We saw the service considered the needs of people with physical, sensory and memory impairments and offered support to improve the quality of the service they received.
Is the service caring?
A relative spoke with us about the level of service saying, "X has been here for several years. It is the best thing that ever happened to them. The staff are marvellous and they really care."
People were supported by kind and attentive staff. We saw examples of staff protecting people's privacy and dignity. Some people needed support to express their views and wishes due to limited verbal skills. Staff told us people expressed their views with body language, facial expressions, sounds and movements. Staff were able to demonstrate positive communication with people. We saw that all people were included in conversations and activities that took place, regardless of their communication needs.
People using the service, their relatives and friends completed an annual satisfaction survey. They all expressed high levels of satisfaction across the service, including relationships with staff. All people using the service and six relatives had returned the questionnaires sent to them.
Is the service responsive?
A person's needs had changed significantly and continuously in the short time they had lived at the home. We saw from records and speaking with staff that the service had responded to the changing needs and complex health care needs of the person. The service had worked well with other agencies to provide a care and treatment regime to continue to meet the person's health and social care needs. This was confirmed by a health care professional we spoke with. Additional specific training had been provided for staff.
The service sought people's views through questionnaires, monthly meetings and individual reviews. We saw from meeting minutes and audits that proposals and suggestions raised by people were listened to and implemented.
Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People were supported to maintain relationships that were important to them. We saw that this included family contacts and relationships with people in other locations they had close relationships with.
Is the service well-led?
The service worked well with other agencies to ensure that people received their care in a seamless way.
Staff worked alongside the registered manager. They had an open dialogue and told us they could raise areas of concern at any time. Staff told us they could raise any areas of concern at regular team meetings, supervision and appraisals. Staff understood their role and responsibilities. They told us they were listened to and were well-supported by the manager and colleagues.
The service had a quality assurance system in place. Quality managers had carried out reviews of the service each month. Suggestions for improvement or change had been fed back to the service. Action plans had been completed where there had been shortfalls. The views of people who used the service, relatives and staff had been sought by the provider and opportunities to change things for the better addressed promptly. We saw and were given examples of this. As a result the quality of the service was continuously improving.