In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.Before the inspection we had received concerns that there was a lack of meal preferences for people using the service, there was a lack of social interaction, the home was short staffed and that staff were not wearing uniforms. The concerns also stated that people's personal care needs were not being met effectively and that call bells were not always accessible to people. It was also stated that people were being injured due to poor moving and handling practices. Concerns had also been raised that when complaints were made some improvements were seen but these were not maintained.
On the day of our visit 57 people were using the service. Below is a summary of our findings based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask.
Is the service safe?
We did not see any evidence to suggest that people were at risk from poor moving and handling procedures. We observed staff supporting people using a hoist and this was carried out in a safe way. Information within accident and incident records did not indicate that injuries were caused by poor moving and handling practices.
The company policy was that staff did not wear uniforms. A staff dress code was in place to guide staff on suitable clothing. Visitors that we spoke with told us that they preferred staff to be in uniform so that they could be identified. However the majority of staff did wear name badges and personal protective equipment was provided to ensure infection control measures were maintained.
We saw from the staff rotas and from discussions with staff there had been a period of reduced staffing levels. The staffing rotas on the week of the inspection demonstrated that there were some days when the residential unit were short staffed. We were advised that staff from the nursing and dementia unit would be used to cover these shifts. However the rotas seen did not demonstrate this.
Is the service effective?
The training records showed that moving and handling training was provided on an annual basis and we saw that the majority of staff were up to date with this training.
People's care plans were up to date and demonstrated that families were involved in the development and reviews of care.
Some daily records were not consistent in the information they provided. For example there were inconsistencies in the records completed regarding people's continence needs being met. This meant that it could be interpreted that people's continence needs were not always met.
Is the service caring?
We observed that people's dignity was maintained and saw a positive relationship between the staff and people using the service.
One person using the service told us; 'All of the staff are nice, very kind and helpful.' A visitor said: 'I don't have any concerns, I come every day and I haven't found any problems. The staff always make me feel very welcome.'
Two activities coordinators were employed at the home and on the day of our visit external entertainers were providing musical entertainment at the home. People we spoke with told us that they enjoyed this. One person said; 'I thought it was very good, lively and good fun.' Another person said; 'I enjoyed that and sang along.'
Is the service responsive?
There was no information in peoples care records regarding their choices and preferences in how they received their care, preferred food and drink and regarding their interests or hobbies. Information provided to the cook was also very limited about people's meal preferences. This meant that there was no evidence to show that people had been consulted about their preferences to ensure the support they received was personalised to meet their wishes.
We saw that call bells were mostly accessible to people. However we identified that one person's call bell was not within their reach. This person hadn't noticed this and confirmed that they had not needed to call for staff support.
Throughout the day we heard call bells being used and these were responded to promptly.
Is the service well-led?
We were informed at this visit that the registered manager had not been working at the service since April 2014. A new manager was in post but they were not available on the day of our visit. We were advised that further plans were in place to change the management of the home in the following weeks.
Staff indicated that over recent months they had not felt empowered to carry out their duties effectively. However it was evident that these concerns had been identified and were being addressed through support from senior managers and the manager of a nearby home which was also owned by the provider.
We looked at the records of complaints received and saw that some complaints did not provide sufficient information regarding the actions that had been taken and the outcome. This meant that there was insufficient evidence to demonstrate that all complaints had been addressed promptly and effectively to ensure people's welfare was maintained.
We identified at the inspection that we had not been informed about two safeguarding investigations and an injury to a person using the service. This meant that the registered person had not notified the commission, as required regarding these matters.