This inspection took place on 9 and 10 December 2015 and was unannounced. The home provides accommodation for up to 101 people, who require nursing care. There were 87 people living at the home when we visited.
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 2008 and associated regulations about how the service is run.
Arrangements to manage medicines safely were not always being followed. This meant medicine administration records were not always accurate and staff could not account for all medicines. In some cases, information about when staff should administer ‘as required’ medicines was not available. Staff left medicines which had not been given, unattended. Meaning they could have been taken by another person and caused harm.
Decisions taken on behalf of people were not always documented in accordance with legislation designed to protect people’s rights. People had not always been consulted in making decisions about their care. Staff were not always following the legislation that protected the liberty of people living at the home as they had not considered someone’s best interest with regards to using a positioning belt when they were using their wheelchair.
Every floor supported people who were older adults, some of whom were living with dementia or had mental health care needs as well as physical health needs. There were registered nurses as well as care staff on every floor. Staffing levels for each of the three floors of the home had been determined by the level of need for that area. This was not always been sufficient during mealtimes.
Staff recruitment had not completed all the required checks to ensure staff’s suitability of working with vulnerable people before they began working in the home as the service had not obtained full employment histories for their staff. Staff knew how to keep people safe; they were knowledgeable about the signs of abuse and how to report their concerns.
People were not involved in assessing, planning and agreeing the care and support they received. Care plans were not personalised to meet people’s individual needs. Risks to people were not always personalised and appropriate actions had not been documented. There were risk assessments in place for pressure injuries, malnutrition, falls and confusion, these were recorded, monitored and managed effectively.
Care plans did not always show people’s current health and support needs were being met. One person who had diabetes was not having their blood sugars monitored as documented. Failure to identify any changes could have resulted in a hospital admission. Reviews of care were conducted regularly and care records showed that people’s needs were met.
There were a variety of activities for those people who were able to attend the activities room. There was a lack of mental and physical stimulation for those who were being cared for in their bedrooms. The provider sought, and acted on, feedback from people, for example in changing the activities they supported people to take part in.
Effective systems were not in place to assess, monitor and improve aspects of the service, such as the management of risks to people, medicines and care planning.
People, staff and professionals felt the home was organised, well-led and praised the registered manager, who they described as “approachable”. Staff understood their roles and worked well as a team. They were motivated and enjoyed working at the home.
Staff were encouraged to gain formal qualifications in health and social care and received appropriate support and supervision in their roles.
People had mixed views about the quality of the meals and were not always supported to eat and drink well. People were supported to attend health care appointments and saw doctors, psychiatrists, nurses and other health professionals when needed.
Appropriate arrangements were in place to deal with foreseeable emergencies, such as a fire. People had individual evacuation plans in place and took part in regular fire drills
We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.