Archived: Sister Dora Nursing Home

Below is a summary of our finding based on our observations, speaking to people who used the service, the staff supporting them and from looking at care and medication records. We considered our inspection findings to answer the questions we always ask '

Is the service safe?

Improvements have been made to certain aspects of the management of medicines. Record keeping in this area has improved.

We saw that there were still areas of concern with the use of some prescribed medication, the safe storage arrangements and out of date medication. We have asked the provider to tell us how they are going to improve their service in relation to medication

practices.

Is the service responsive?

People who used the service have benefited from a medication review. Amendments have been made to their prescribed treatments and some treatments have been discontinued.

Is the service caring?

One person told us told us they had their medication on time and creams applied when they were supported with personal care. They said: 'I am very comfortable and they [the carers] are very caring'.

Is the service effective?

Information is available for the use of occasional medicines, so that people can have medication such as pain relief when they require it. Further information would be beneficial to support the administration of these occasional medicines for people who have limited verbal communication.

Is the service well led?

Staff have received training and updates in medication management. However they now need to put the theory into practice with regard to the safe storage and disposal of medication.

Below is a summary of our finding 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?

Some people cannot make decisions because of frailty or ill health. Professionals and relatives were involved in taking and making decisions to ensure they were in the person's best interests.

The service places people at risk because of unsafe handling of medication, so people do not always receive their medicines as prescribed and intended. We have asked the provider to tell us how they are going to improve their care in relation to medication practices.

Is the service responsive?

We saw staff were available in areas throughout the home; they supported people in an appropriate way. Some people who used the service told us there were times that they had to wait for support when they requested help.

Staff were aware of people's needs but did not always respond in a timely way. For example, there were delays in making referrals to other health and social care professionals. Staff tell us that some delays were caused by time and workload constraints. We have asked the provider to tell us how they are going to deal with this.

Is the service caring?

Most people who used the service told us that the staff were good and they were satisfied with the care and support provided.

Visitors told us that they were satisfied with the care provided to their relative.

Is the service effective?

A visiting health care professional told us that improvements had been made recently with referrals for their service being appropriate and that staff had a better understanding of mental health issues and behaviours.

Care records identify people's needs, choices and preferences but some were not reviewed or updated on a regular basis or when a change was identified. We have asked the provider to tell us how they are going to improve the recording and reviewing of people's care needs.

Is the service well led?

The service had systems in place to review the quality and safety of the service. These were not always completed when they were required to be. We have asked the provider to tell us how they are going to improve the quality of the monitoring of the service.

The manager of the service is currently away from the service. The Deputy Care Home Manager is currently acting up in the absence of the Care Home Manager.

Improvements were needed to ensure that records were accurately completed, maintained and provided the necessary information to meet the needs of people who used the service.

We spoke with or observed everyone that lived at the home. We spoke with managers and the majority of staff at the service.

People we spoke with were happy with the care they received. One person said: "I like it here. The staff are very kind and do what they can to help me". Relatives we spoke with were pleased with the care provided.

Some people were unable to speak with us either because of frailty or personal preference. We saw that staff were available to help and support people when assistance was needed.

Staff gave a detailed account of the specific individual needs of people. We looked at the care records for four people who used the service and found that the recorded information was up to date and corresponded with what staff had told us.

We spoke with a visiting healthcare professional. They told us that at the time of this inspection they had no concerns with the care provided to people.

Staffing levels had improved since our last inspection. A member of staff told us they were still very busy but now had additional time to attend to their tasks, provide the care that people needed and did not feel so rushed.

We saw that improvements had been made to records and the documentation required, ensuring that people received the support they required in a consistent and effective way.

We spoke with the majority of the people who used the service. We spent time in the lounge and dining areas and observed the interaction between people and staff. One person told us: "The staff are very nice, they look after me and they wash and dress me".

Some people were unable to speak with us because of ill health or frailty, but they smiled and nodded when we asked about their welfare.

We spoke with staff about the care and support they provided each day. They gave a detailed account of the specific individual needs of people. We saw staff supported people in a caring and helpful way.

A relative we spoke with had some concerns that there were not enough staff and about the lack of mental stimulation. They said: "My relative is very happy here and cared for well physically but there is nothing to stimulate him mentally, he just seems to sit all day with nothing to do".

We observed that some people had to wait for support because staff were not available. People we spoke with told us about the shortage of staff.

Records that were required to be kept to protect the safety and well-being of people were missing, incomplete, lacking information and guidance.

We looked at the care planning documentation of six people to see how their care was provided and managed. We talked with staff who were aware of and able to discuss people's care needs. The information recorded in four of the plans did not accurately correspond with what staff had told us. Some records were incomplete and did not give information of people's assessed care and support needs.

People told us that they enjoyed the food that was provided. One person who used the service told us, "I like the food, plenty of choice. Nice meals. Good breakfast, all I could wish for. Food seems to have got better recently and is better than the previous home I was in".

Staff told us their understanding of safeguarding vulnerable people and confirmed they had received training in this.

People told us the staff were friendly, helpful and supportive. Visitors told us that the staff were kind and caring. One person told us, "Staff work very hard but there are just not enough of them".

Some people had their care needs fully met others did not. One person told us " I like living here, the staff are very good to me and all the other people. They try their best and nothing is too much trouble. It's marvellous, there is no other place like it".

We saw some very frail people who were fully dependent on staff to help them with everyday life.

Some people told us the food provided is lovely and they could have alternatives to the menu if they wished to do so. We were unable to determine if the dietary requirements for some frail people was sufficient for their needs as this information was lacking on the monitoring documents. Some staff were unsure of some dietary requirements of some people.

People who used the service told us they would speak with the staff or their family member if they had any concerns. Staff told us they were aware of the procedures to report any concerns they may have. We saw some omissions in staff working practices that have the potential for placing people at risk of harm.

Some records were incomplete and did not give information of people's assessed care needs.