We carried out a review of the data available to us about Freelands Croft Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Freelands Croft Care Home, you can give feedback on this service.
Freelands Croft Care Home is a residential care home providing personal and nursing care to up to 64 people. The service provides support to older people who may be living with dementia. At the time of our inspection there were 56 people using the service.
Accommodation is in a purpose-built building on two floors.
People’s experience of using this service and what we found
We were assured the service had procedures in place to prevent and control infection. The provider protected people’s rights if they lacked capacity to make decisions about whether to stay at Freelands Croft Care Home.
People had good outcomes from the care, support and treatment they received.
People had a service that was well managed and well-led. The leadership and culture promoted high-quality, person-centred care leading to positive outcomes for people. Staff morale was positive after an exceptional period of stress in the adult social care sector, and there was an up-beat, cheerful atmosphere.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk.
Rating at last inspection:
The last rating for this service was good (published 5 December 2019).
Why we inspected
We carried out this inspection in response to information we received in relation to people’s care and treatment meeting their changing needs. We undertook a focused inspection to review the key questions of responsive and well-led only.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively.
We looked at how the provider complied with the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. We look at this in all care home inspection. This is to provide assurance the service protects people's human rights if they are not able to consent to their care and treatment.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has not changed following this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Freelands Croft Care Home on our website at www.cqc.org.uk.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
There were protocols and procedures in place to allow people to receive a visitor safely in their room in line with the latest government guidance which was due to come into force the week after our inspection. There was also a visiting pod in a ground floor lounge for other visitors, and those who were still cautious about the new guidance.
Enhanced personal protective equipment (PPE) and associated training were available for staff who supported a person who used continuous positive airway pressure (CPAP) therapy to help them sleep. CPAP increases the risk of COVID-19 being spread by droplets in the air.
The provider had made adaptations to the home to make it easier to support people safely during the pandemic. These included re-purposing unoccupied rooms for staff use, and using the hair salon for COVID-19 testing. The provider had removed some furniture which was difficult to clean effectively, and spaced the remaining furniture in shared areas of the home to allow for social distancing.
The provider had kept their infection prevention and control policies and procedures up to date to reflect guidance such as the government's winter plan for adult social care. Other policies, such as the provider’s sickness policies had been updated to take into account staff who might be shielding or self-isolating.
The provider had put additional measures in place to support staff who might be affected by the pandemic, such as the opportunity for confidential telephone counselling and a hardship fund. Staff morale was high, and staff felt they had been supported well by the provider.
Freelands Croft Care Home is a residential care home providing personal and nursing care for up to 64 people who may be living with dementia. Accommodation was on two floors in a purpose-built building.
People’s experience of using this service and what we found
People received care and support that was safe. People were protected from avoidable harm and abuse. There were enough staff deployed to support people safely. The provider met good practice standards with respect to managing medicines and preventing the spread of infection.
People received care and support that was effective and based on detailed assessments and care plans. Staff received training to maintain their skills. The provider worked with the local hospital to improve people’s experience when discharged from hospital. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
There were caring and kind interactions between people, their care workers and other staff. These were based on compassion and understanding of people’s needs. Staff respected and promoted people’s privacy, dignity and independence, and encouraged people to be involved in their care.
People’s care and support met their needs and reflected their preferences. The provider was aware of best practice guidance with respect to meeting people’s communication needs. People had access to a range of relevant activities designed to avoid social isolation.
The service was well-led. There was focus on meeting people’s individual needs and preferences. The provider worked in cooperation with other agencies and worked to continuously improve the service people received. This was supported by effective management and quality systems.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.
Rating at last inspection
The last rating for this service was good (published 12 April 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Freelands Croft Nursing Home provides accommodation and personal and nursing care for up to 64 older people who are frail or are living with dementia. Accommodation is provided over two floors with the first floor providing nursing care. At the time of our inspection 54 people were using the service.
The service had a registered manager in place. 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. The service is required by a condition of its registration to have a registered manager.
The provider operated effective quality assurance systems. Regular checks and audits were completed which enabled the registered manager and staff to continually evaluate the quality and risks in the service. We found these systems had been effective in driving improvements for example, in relation to staff supervisions and daily activities in the service for people. Clinical governance systems enabled nursing decisions to be reviewed and monitored to ensure care was being provided in accordance with best practice standards.
The provider implemented safe recruitment practices and we found all the required staff pre-employment checks had been completed to ensure staff would be suitable to work at the service.
People received their prescribed medicines safely and had access to healthcare services when they needed them. People liked the food and told us their preferences were catered for. People received the support they needed to eat and drink enough.
Staff had a good knowledge of their responsibilities for keeping people safe from abuse. Staff sought people's consent before they provided their care and support. Where people were unable to make certain decisions about their care the legal requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.
Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to know what support people required. Staff received training and supervision to support them to meet the individual needs of people effectively.
Staff knew people well and supported people living with dementia to manage their anxiety and agitation. People were treated with kindness, compassion and respect and staff promoted people's independence and right to privacy. The staff were committed to enhancing people's lives and provided people with positive care experiences.
People knew how to make a complaint. People told us the manager and staff would do their best to put things right if they ever needed to complain.
This inspection took place on 25, 26 and 28 January 2016. It was carried out to check on the provider’s progress in meeting the requirements made as a result of our inspection on 9, 10, 12 and 16 June 2015 which resulted in the service being rated Inadequate. As a consequence of this judgement the service was placed in special measures and we have taken enforcement action in response to this failure to meet required standards. We have placed a condition on the provider’s registration that they must not admit any new people to Freelands Croft Nursing Home without the prior written consent of the Care Quality Commission. At the time of this inspection the provider had not requested any new admissions be made to the service.
The previous inspection report in June 2015 identified some serious concerns. Risks to people had not always been managed to ensure their safety, staff had not been supported to understand people’s needs, care plans and records did not reflect the care people needed and received and the provider had not adequately monitored the quality of the service and make improvements when required to keep people safe.
The provider took action to address the concerns we found at the last inspection and submitted their service improvement plan telling us how they were addressing the areas in need of improvement. At this inspection we found the provider had made improvements to address the five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 found at the last inspection. Following this inspection the service has not been rated as inadequate for any of the five key questions and has therefore been taken out of special measures. The Interim Area Manager acknowledged that more time was needed to ensure these improvements became part of the routine practice at the service and were maintained over time before people could always be confident that they would receive good care.
A registered manager was not in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered person’. 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. The provider had recruited a new Home Manager in the past month and they had started the application process to be registered with the Care Quality Commission (CQC) to ensure the provider met their registration requirements. The provider was working at inducting the new Home Manager and supporting them to sustain these improvements.
The service had improved the operation of their quality and risk monitoring systems and routine monitoring checks and audits had been completed in the past six months. These had supported the Relief Home Manager to identify areas of risk or quality concerns. Prompt action had been taken to address issues identified. Action plans had been monitored and were effective in driving service improvements for people. The provider was aware of areas that required further improvements and had plans in place to address these.
Staff we spoke with all knew what the concerns were and what action was required from them to improve the service. The provider was developing a culture of learning, development and problem-solving with staff empowered to find solutions to ensure people remained healthy and safe. Staff told us that they felt valued and felt able to put good care and people’s experience at the heart of their work.
Improvements had been made in how risks to people’s health and safety were identified and managed. People’s risks and needs had been re-assessed and people and their relatives were involved in planning their care. People’s treatment decisions and progress were reviewed regularly by appropriate staff to ensure the care and treatment they received remained in line with best practice standards. Staff understood how to support people to minimise risks where possible. Some improvements had been made to regularly review people’s care plans however, improvements were still needed in staff reviewing people’s mobility plans promptly following falls and ensuring the records informing people’s weight maintenance plans were accurate.
Appropriate systems were in place to order, store, administer and dispose of people’s medicine. Further improvement was needed to ensure people’s medicine administration records were always completed promptly.
Following our inspection the provider had reviewed their nursing provision. They had made the decision to only provide nursing care on one floor of the service limiting their nursing beds to 32 and therefore reducing the number of nurses they required. We found there were sufficient staff that knew people’s needs and preferences. The new Home Manager had identified some improvements were still needed in how staffing was co-ordinated on each shift to ensure staff knew what was expected of them and were available to people when needed.
Staff had started to receive regular support and supervision to enable them to identify solutions to problems, improve care practices and to increase their understanding of work based issues. Agency nurses had been inducted effectively to ensure they had the necessary knowledge of the provider’s policies, care practices and people’s needs to care for people in the service appropriately. Time was needed to ensure this would become part of the routine staff support practices in the service.
The service had improved their support to people who refused food and drink as recommended by the Speech and Language Therapist (SALT). The service had contacted the SALT for advice and had adjusted people’s nutritional support to reflect their preferences whilst keeping them safe.
Staff understood their responsibility to follow the Mental Capacity Act 2005 (MCA) code of practice to protect people’s human rights. Best interest decisions were being made to agree restrictions in people’s care plans, with input from family who knew people; however it had not always been recorded how the decision had been made that these restrictions did not deprive a person of their liberty. We have made a recommendation about the recording of mental capacity assessments and best interest decisions to evidence how restrictions placed on people to keep them safe, had been considered not to meet the requirements of Deprivation of Liberty Safeguards (DoLS).
Appropriate systems were in place to check care equipment remained safe for use and available when needed. Further improvements were needed to ensure these checks were always recorded.
Staff demonstrated kindness and compassion. There was a clear consistent approach when people became distressed and staff, picked up on people’s attempts to communicate and engaged with them in a caring manner.
People and their relatives were given opportunities to provide feedback about the service and raise their concerns. They had access to the complaints policy and monthly resident and relatives meetings had been held to keep people informed of the progress made against the service improvement plan.
Relatives and staff told us they had seen improvements in the service especially in relation to staff consistency. However, they consistently told us these would need to be sustained before they would be satisfied that the service was consistently providing good quality care.
Freelands Croft Nursing Home provides accommodation and personal and nursing care for up to 64 older people who are frail or are living with dementia. Accommodation is provided over two floors. At the time of our inspection 56 people were using the service.
We received concerns about people’s safety and undertook an unannounced inspection on 9, 10, 12 and 16 June 2015 to look into these concerns.
During the inspection, we identified a number of serious concerns about the care, safety and welfare of people who received care from the provider. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have taken enforcement action in relation to the regulatory breaches identified. We imposed a condition on the provider’s registration in respect of the regulated activity, Accommodation for persons who require nursing or personal care, they carry on at Freelands Croft Nursing Home. The provider must not admit any new service users to Freelands Croft Nursing Home for the purposes of this regulated activity without the prior written consent of the Care Quality Commission.
The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'.
The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
A registered manager was not in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered person’. 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. The management of the service had changed in the past month following concerns identified by the provider about the quality of the service provided at Freeland’s Croft Nursing Home. A new deputy manager, acting home manager and area manager had been appointed to address these concerns. The provider had started recruiting for a new registered manager. We had not received a notification to cancel the previous manager’s CQC registration and therefore their name still appears on the CQC website as registered manager for the service.
The provider had not effectively implemented their quality and risk systems and routine monitoring processes had not been completed in the past six months. The previous area manager had raised concerns about the management of the service and undertook a Home Review Audit of the service on 10 March 2015. Widespread shortfalls, similar to the ones we found at this inspection, were identified and a basic action plan was developed to address these concerns. Some action had been taken but the provider’s monitoring system had failed to ensure action was taken in line with their action plan. Significant improvements had not been made and people remained at risk of receiving inappropriate or unsafe care
Action had not been taken by the provider to ensure the information in people’s care records were accurate and could effectively be used to evaluate and identify the correct treatment and care required for people. Nurses could not be assured from the records that people had received their medicines as required. The provider had not taken action to improve the quality of record keeping which they had identified as a significant concern during the internal audit on 10 March 2015. People remained at risk of receiving inappropriate or unsafe care through the provider’s failure to maintain accurate, complete and contemporaneous records in respect of their care and treatment.
People’s individual risks were not managed safely. Risks had not been fully assessed and staff had not received sufficient guidance on how to support people to minimise risks where possible. Skin pressure relieving equipment including air mattresses, were not monitored to ensure they were used in a safe appropriate manner.
The provider did not ensure that there was enough suitably competent and experienced staff to meet people’s needs safely. The provider had ensured that agency nursing staff had been engaged to support the staffing levels in the home. However, there were insufficient numbers of nursing staff who understood people’s individual needs and the support they needed to stay safe. The provider had not identified the impact that temporary staff, who did not know people, would have on the deployment of regular staffing levels. The skills and knowledge mix of the staff had not been reviewed continuously and adapted, to keep people safe.
Staff did not receive regular support and supervision to enable them to identify solutions to problems, improve care practices and to increase understanding of work based issues. Agency nurses had not been inducted effectively to ensure they had the necessary knowledge of the provider’s policies, care practices and people’s needs to care for people in the home appropriately.
People’s health needs were not always understood. People who lived with diabetes were not consistently supported in line with nationally recognised guidelines to adequately manage their blood glucose levels so as to protect them against diabetes-related complications. Making appropriate treatment decisions for people were complicated by care plans not providing health professionals with up to date and accurate information about people’s treatment histories and how people’s health had deteriorated or improved over time.
There were shortfalls in the support people received to meet their nutritional and hydration needs. People were at risk of aspiration and/or choking as clear support guidelines, based on Speech and Language Therapy (SALT) recommendations, were not available to staff when supporting people with swallowing difficulties. Where records indicated potential shortfalls in people’s fluid intake, nurses failed to investigate and take appropriate action to ensure people had enough to drink.
Staff understood their responsibility to follow the Mental Capacity Act 2005 (MCA) code of practice to protect people’s human rights. Two people were subject to Deprivation of Liberty Safeguards (DoLS) and the DoLS team was processing a further 12 applications for people living at Freeland’s Croft Nursing Home. The service was reviewing everyone using the service to assess whether further DoLS applications were required. Best interest decisions were being made to agree restrictions in people’s care plans, with input from family who knew people, enabling staff to keep people safe whilst awaiting the outcome of the DoLS applications.
Staff demonstrated kindness and compassion but some did not understand and support people living with dementia appropriately. A lack of a clear consistent approach and understanding on current good practice, at times, resulted in staff acting in an uncaring way. They did not pick up on people’s attempts to make contact or take part in activities resulting in opportunities to engage with people living with dementia being missed.
Staff did not always have the information they needed to meet people’s needs and preferences. Needs assessments had not always been used to plan people’s care in a timely manner following their admission to the service. People’s care plans were not always reviewed monthly in line with the provider’s policy to ensure people’s changing needs were identified and their care adjusted accordingly.
You can see what action we told the provider to take at the back of the full version of the report.
The inspection took place on 18 and 25 November 2014 and was unannounced.
The previous inspection, in September 2014, was to follow up on three warning notices and three regulations where there had previously been breaches. Overall, the provider had made many improvements and had achieved compliance with five of the six regulations. The provider had not made all the necessary improvements to the management of medicines however, and we served another warning notice, requiring the home to achieve compliance by 20 October 2014. The home was also in breach of the regulation relating to quality monitoring. This inspection, in November 2014, showed the provider had made improvements in all areas where we had previously found breaches in legal requirements.
Freelands Croft Nursing Home provides personal and nursing care to up to 64 older people and people living with dementia. When we visited there were 49 people living at the home. The home is purpose built, with accommodation over two floors. People have their own rooms with ensuite facilities and there is a dining room, sitting room and activity room on both floors.
The service is required to have a registered manager as a condition of its registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The manager had submitted their application to register with the CQC at the time of the inspection.
The manager had placed a strong focus on supporting staff to provide personalised care, in line with people’s needs and preferences. People living at the home, their visitors and visiting health and social care professionals were complimentary about the quality of care and the support provided by the manager and staff.
People told us they felt safe and staff were kind and compassionate, treating them with respect and dignity. Staff provided practical support and helped people to maintain their health and wellbeing. They were trained to provide effective care, based on best practice guidance. This included training in caring for people with dementia as well as training to support specific health conditions.
People’s safety was promoted through individualised risk assessments and safe medicines management. Arrangements were in place to check safe care and treatment procedures were undertaken and to improve the quality of care provision. There was a commitment to provide high quality care and apply learning from incidents, feedback and training.
People’s health needs were looked after, and medical advice and treatment was sought promptly. The home involved health and social care professionals when necessary, following their advice and guidance. This included making decisions on behalf of people when they lacked the mental capacity to make decisions for themselves about important matters.
Staff recruitment processes were robust. There were sufficient staff and staff understood their roles and responsibilities to provide care in the way people wished. They were responsive to people’s specific needs and tailored care for each individual. Staff worked well as a team and were supported to develop their skills and acquire further qualifications.
The home aimed to enable people to maintain their independence and socialise as much as possible. People were cared for without restrictions on their movement.
The manager promoted a culture of openness and had made changes at the home to improve the morale of staff and to promote a culture where people came first. There was a clear management structure and systems were in place to deliver improvements in care.
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well-led?
We found the service was caring, but evidence showed that the service was not always safe, effective, responsive or well led. We served warning notices in relation to medicines management, care and welfare and staffing and required the provider to achieve compliance with these essential standards by 11 August 2014. We also issued compliance actions in relation to supporting workers, assessing and monitoring the quality of service and records management. The provider sent us their action plan showing how they would address the issues we found.
On 16 September 2014 we re-inspected Freelands Croft Nursing Home to assess whether compliance with the three warning notices and three compliance actions had been achieved. We spoke with the new manager, 14 staff members, 12 residents or their relatives and two visiting healthcare professionals. Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
Systems for learning from accidents and incidents were in place and had been effective in reducing falls.
Staffing levels and staff skills were appropriate for the needs of people using the service. New staff had been recruited since our last inspection and the use of agency staff had reduced. The staff we spoke with understood people needs and how to keep them safe.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards were being applied for in line with legislation.
Some unsafe aspects of medicine management, that we had reported in the warning notice, had not been addressed. We also found other areas of medicine management that were not safe and we advised the service of our concerns. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe management of medicines.
Is the service effective?
People's individual health and care needs were assessed and care planning included clear guidance for staff. Care was reviewed when people's needs changed. Care and treatment was coordinated effectively and staff understood their roles. External health professionals were involved in people's care appropriately and their advice was followed.
Best interest decisions had been carried out when people were not capable of making their own decisions.
Staff support was in place, with training and professional development. The delivery of care was clearly documented
Is the service caring?
People using the service and relatives told us that staff were kind and caring. We observed that staff treated people with respect.
Staff provided emotional support to people using the service and their relatives. Carers had been invited to meetings at the service, including a dementia support discussion. We observed that staff spent time talking with people and were patient, friendly and interested in people's views.
Staff encouraged people to be independent and make their own choices.
Is the service responsive?
The service responded to people's emotional needs by developing the environment to provide different areas of sensory stimulation and diversion. For example since our last visit the service had installed an indoor 'woodland' area, a fish tank and there was a cage of two budgerigars on the dementia floor. These had helped give people pleasure and interest.
The service responded to changes in people's health needs and sought advice from health professionals promptly. Health professionals were positive about the care people received and the way staff worked well together to provide the care people needed.
Opportunities had been provided for people using the service, their relatives and friends to meet with the manager or raise concerns. These were dealt with promptly.
Is the service well led?
The new manager of the service had been in post eight weeks when we inspected and staff, relatives and visitors told us that the leadership, and staff morale, was much improved. Staff understood their roles and responsibilities and there was effective team working. Staff demonstrated a commitment to improving the quality of service provided.
Systems for monitoring quality had not identified that the issues raised in the warning notice in relation to medicine management had not been addressed. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring the quality of service provision.
Staff said they received good support and training, and enjoyed their work. They said their views were listened to, including their ideas for improving the service.
We spent two days at the service and spoke with the relief home manager, the deputy manager and 12 members of staff in different roles. As part of this inspection we also spoke with eight people using the service, ten visitors including healthcare professionals and relatives and reviewed documents relating to the care of 18 people using the service.
We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
The service had a poor track record on keeping people safe. There had been a recent overarching safeguarding meeting held to review a range of safeguarding referrals and concerns.
The systems for learning from audits, investigations and feedback were not robust. Although there was evidence of recording and reviewing incidents and accidents, arrangements were not in place to ensure that staff learnt from audits, investigations, complaints, accidents and incidents to improve arrangements for care. The provider failed to implement improvements which meant there was an increased risk of harm to people. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to using audits, investigations and feedback from people to improve the service.
We found that staffing levels and skills mix were not appropriate for keeping people safe. There were insufficient staff with the necessary knowledge and experience of people's needs to keep people safe and support their health and emotional wellbeing. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe staffing.
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The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Although a DoLs had been initiated for two people using the service, we found that another person expressed a wish to leave the home and a DoLs had not been requested of the supervising authority. This meant they were being unlawfully restrained against their will.
We found that systems for the management of medicines were not robust and people were at risk from inappropriate administration, storage and recording of medicines. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe management of medicines.
Is the service effective?
The service was not always effective. Healthcare professionals said their advice was not always communicated and followed effectively.
Most aspects of people's health and care needs were assessed and care was planned and reviewed. However, we found that some aspects of care were not risk assessed and managed effectively. For example, there were no care plans for people with epilepsy, and there were gaps in the recording and/or delivery of people's care and treatment. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to protecting people from the risks associated with inappropriate or unsafe care.
Most care plans and risk assessments had been reviewed, and most staff showed a good knowledge of people's care needs. However we found that staff had not been supported with regular training and supervision from management. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff to enable them to deliver care of the appropriate standard.
Is the service caring?
The service was caring. People told us that staff were kind and caring. We heard that staff were 'brilliant', 'kind' and 'The staff are very good'. We observed that staff spoke with kindness and respect and created a happy atmosphere.
We observed care and support being provided to people in a kind, patient and considerate manner. Staff encouraged people but allowed them to make their own choices.
Is the service responsive?
We found the service was not always responsive to changes in people's needs. Although people were referred to healthcare professionals for specialist advice and treatment, relatives and healthcare professionals told us that they were not called promptly.
We found that access to activities was limited although staff tried their best to support people in a timely way.
Where people had complaints, they told us their concerns were not responded to appropriately and they were not always satisfied with the outcome.
Is the service well led?
We found the service was not well led. There had been three home managers in 2014 and service improvements identified from reviews, inspections and investigations, had not been implemented and sustained. Staff and visitors told us that they were not listened to and were disillusioned with the organisation and management of the home. Most staff told us they felt poorly supported. However everyone we spoke with said they were optimistic that the newly appointed manager would be effective, because he sought their views, listened to what they had to say and had visibility on 'the floor'.
Our inspection showed that the system for monitoring quality was not effective in identifying improvements and ensuring they were implemented. There was a quality assurance system in place, however this had not enabled the service to address issues identified for improvement to minimise the risks to people using the service.
We found that people were at increased risk of experiencing falls and urinary tract infections.
Not all staff had received appropriate dementia care training to enable them to meet people's increasingly complex needs.
The arrangements for the administration of medicines were not sufficiently robust.
The number of staff had been recently increased, however this required further review. The provider had taken steps to recruit permanent staff; however we found that there was a high usage of agency staff.
Incidents had been investigated and trends within the home had been monitored.
People had been consulted about their care and preferences. Where people lacked the capacity to consent to decisions about their care, the correct processes had been followed.
Staff were observed to be caring and demonstrated that they had an understanding of people's individual needs. People had care plans to meet their identified needs. Risk assessments had been completed and there were plans in place to manage risks to people.
People had been provided with sufficient choice in relation to their food and drink. They had been provided with appropriate support to ensure that their nutritional needs had been met.
We found that staff had worked with other agencies to ensure that people's needs had been met.
The home was clean and well cared for. We found that some staff needed to update their infection control training. The registered manager had already identified this need and had made appropriate arrangements to meet this need.
This inspection on the 10 January 2013 was for the purpose of following up on whether the provider had achieved compliance with these standards.
We spoke with people who use the service and their relatives. People told us that they were 'very happy with the care' and 'I like it'.
We found that the use of agency staff had significantly reduced and that there was more consistency with the agency staff that had been employed. This meant that the staff team were aware of people's individual needs when providing them with care. People told us that the staff treated them well.
When agency staff were used, checks were made to ensure that they had undergone the required training. They were also provided with enough information to provide people with safe care.
During the inspection we found that medicines were being managed safely and that nurses had received further training.
Staff were up to date with their safeguarding training and were able to apply their knowledge. People's relatives told us that they felt the care provided was safe.
We also found that the manager had ensured that the pre-employment checks for staff were thoroughly completed.
A relative told us that the care was very good, whilst another told us 'it has changed a little bit.' Concern was expressed regarding the high use of agency staff. Another told us that the staff seemed under pressure and didn't know people.
People were provided with information about the service; however there was a lack of written evidence to demonstrate that they had been involved in their care plans or had been offered a copy. People's needs were assessed and risk assessments were completed. Not all staff however particularly agency staff were sufficiently familiar with the care plans.
Not all staff had received safeguarding training, in particular some agency staff.
There were insufficient permanent staff; therefore there was a heavy reliance on agency staff who received an inadequate induction.
The provider had systems to monitor the quality of the service provided, but they were not fully effective.
There were concerns around medicines. The records showed that medicines had not been administered as prescribed by the doctor.