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Inspection report

Date of Inspection: 6 May 2014
Date of Publication: 26 June 2014
Inspection Report published 26 June 2014 PDF

Overview

Inspection carried out on 6 May 2014

During a routine inspection

There were 62 people living at the service, on three different floors, when we visited. We focused on Elgar on the second floor where there were 26 people. We spoke with different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. We spoke with two relatives of people who used the service and three members of staff. We also met and talked with an independent quality assessor who was visiting the home on the day that we were there. The people using the service were unable to answer complex questions, some did not communicate verbally and so we spent time observing people, to see how they were cared for and how staff interacted with them.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five key questions that we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We saw that a comprehensive risk assessment had taken place before people had gone to live at the home. Care plans reflected assessed risks. We saw that when a person had been assessed as having a swallowing risk, appropriate diet and fluids had been provided. Some people had been assessed as having actual or potential risks of malnutrition and, following referral to a dietician, received nutritional supplements. Where equipment was used to care for people, this had been serviced regularly and staff knew how to use it. There were enough hoist slings of the appropriate size but they were not allocated for individual use. This can lead to a risk of cross infection.

All staff had received the appropriate training to meet people�s needs, which included training about safeguarding people. Measures were in place to safeguarded people from abuse. We saw that an application to the court of protection had recently been made on behalf of a person in relation to deprivation of liberty. The decision to make the application had been made following a best interest meeting which involved the appropriate people, and was recorded.

Is the service effective?

One relative told us, �This is a nice place for people to live.� Another said, �I�m happy and (they) are too.� And �You�d go a long way to find a better home.�

We saw that care and support had been carefully planned to meet people's needs and included personal preferences. We saw that the service had been supported by a specialist nurse over an 18 month period to improve the safety and quality of care. Forging stronger links to primary care and improving the involvement of relatives in decision making had helped trained staff at the home to become more confident in managing health needs for people. This meant that fewer people attended the hospital accident and emergency department (A&E) than in the previous year. It is beneficial for people to be able to remain in familiar surroundings, cared for by familiar staff who understand their needs. Staff told us the process had improved their understanding of the Mental Capacity Act 2005 and that when helping people to make decisions and choices, they paid more attention to the preferences and choices that individuals had made when they had capacity than they had previously done.

Is the service caring?

Relatives that we spoke with told us that some staff were particularly caring and that they all, �Do a good job.� A member of staff was described as, �Brilliant, very caring.� Another relative told us that staff had time to stop and talk to people which they felt showed that they cared about them. A member of staff told us that the care staff tried their best to help people and that, �People surprise you, sometimes we laugh a lot.� This was said in a way that showed us that they cared about the people that they cared for. We spoke with the manager of the service who was enthusiastic about plans to improve people�s lives by increasing the involvement of relatives and volunteers so as to offer more outdoor activities and social interaction. We observed that when staff interacted with, or helped people they were kind, patient and cheerful.

Is the service responsive?

The service was responsive to the changing needs of people using the service and to suggestions and comments made by relatives. We saw that care plans were regularly updated and were changed when people�s needs changed. A relative who often helped a person at mealtimes told us that staff had listened to them about how to help the person to eat and drink and had learnt to do it the same way. Another relative told us that they had complained about a carpet in a person�s bedroom which had become soiled. They told us that the service had replaced it with laminate flooring which was easier to clean. They also told us of the close relationship that they had with staff at the home and that, �They always phone me if there are any problems.�

We saw records, and staff told us that changes had been made in response to suggestions, incidents and preferences of people using the service. The manager told us that any concerns or complaints were discussed in a meeting every Monday. We saw a recent letter inviting relatives to join in a consultation about planned refurbishment of the home. We saw many examples of responses to relatives' concerns or suggestions and the results of the annual satisfaction survey was followed up with an action plan.

Is the service well led?

We spoke at some length with the manager. They told us about many changes that had taken place during the last year to improve the quality of care for people and the experience of staff. The manager had identified the need for all staff to have a greater understanding about caring for people with dementia, and appropriate training had begun. The service had an effective system to monitor the quality of the service they provided. This included independent and local authority quality assessments, an annual satisfaction survey to monitor what relatives thought about the quality of the service and regular meetings with relatives. We saw that action plans had been formed and implemented to address any shortfalls in performance. Staff told us that the manager and deputy were approachable and responsive. A member of staff told us that a lot of changes had taken place in the last few years and that some staff had not been happy. Some staff no longer worked at the home. They also said, � There is a great difference, its more stable and much better (than before)� and �I�m happy working here.� This all showed us that the service was well led.