On 14 August 2013 we were made aware, by the local authority safeguarding team, of two separate incidents earlier in August 2013, of people leaving the home alone without staff realising. Both people were living at the home and were known to have dementia. The safeguarding investigations were ongoing at the time of our inspection.At our last inspection on 03 January 2013 the registered manager told us that seven of the 14 people living at the home had dementia. In our report about that inspection we pointed out to the provider that the design, layout and décor of the home did not provide an environment that maximised the existing abilities of the people with dementia or that promoted their independence.
On the day of our inspection, there were 13 people living at the home. Of the 13 people, six had a diagnosis of dementia. A further four people were confused with some early signs of dementia. All people living at the home were in the process of having their needs re-assessed by health or social care professionals.
We were accompanied on our inspection by a specialist advisor, with specific expertise and knowledge in creating dementia friendly environments, understanding behaviour, care planning and dementia awareness training.
At the time of our inspection, the registered manager was on extended leave and was not managing the home on a day to day basis. The provider had appointed a new interim manager, who was in the process of applying to CQC to become registered.
People told us they were treated with respect and their rights to privacy and dignity were protected. This was confirmed by observations we made on the day of our inspection. One person told us "they are always very kind to me here".
However, we found people were not provided with appropriate opportunities that encouraged, supported and promoted their independence and community involvement. The design and layout of the premises and grounds were not safe or suitable for people living at the home with dementia and/or confusion.
There were no effective recruitment systems in place to ensure that staff were of good character and safe to work with the people living at the home. Staff had not received appropriate training to enable them to deliver care and support to people living at the home safely and to an appropriate standard. The provider had not ensured that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced staff who knew the home and the needs of the people living there.
We found confidential personal information about members of staff was not stored securely and was not kept in line with current legislation such as the Data Protection Act 1998.
The registered person had failed to notify us of an allegation of abuse (neglect), an application to deprive a person living at the home of their liberty and a revision of their statement of purpose. This meant that people living at the home could not be confident that important events relating to the management of the home and their care, safety and welfare were reported to us when required so that, where needed, we could take appropriate action.