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Archived: Andrew Cohen House Good

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Inspection report

Date of Inspection: 29, 30 July 2014
Date of Publication: 11 September 2014
Inspection Report published 11 September 2014 PDF


Inspection carried out on 29, 30 July 2014

During an inspection in response to concerns

The inspection team was made up of two inspectors, a pharmacy inspector and an expert by experience. There were 55 people using the service during our inspection. We spoke to fourteen people who lived at the home and with six relatives.

We set out to answer our five 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. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found there were not appropriate arrangements in place to ensure staff managed the risks associated with the use and management of medicines. We were informed by the manager and the director that all issues identified by the inspection would be investigated and action taken.

People were sometimes cared for by an insufficient number of staff. The staff turnover was also high. The service had some people who had dementia and so were at risk of becoming disorientated by having an inconsistent staff team.

People told us they felt safe. One person told us, �I�m not frightened of anyone here.� The staff we spoke had a basic understanding of safeguard procedures as they had not all received training in this. However, staff said that if they witnessed poor practice they would report their concerns.

The provider had notified the local authority as required of some incidents that had occurred in the home under safeguard procedures. However we had been made aware of other incidents that had not been reported. This places people at risk of allegations not being properly investigated.

There were no people having restrictions placed on them through the Deprivation of Liberty Safeguards (DOLS). These safeguards apply where it is thought that it is in someone's best interests to be placed in a care home but they lack the capacity to make a decision about what is being proposed for them. In these circumstances the provider must apply for authorisation to deprive the person of their liberty. We found that the manager was not aware of a recent Supreme Court ruling that impacts on the circumstances when an application should be made.

Risks to people's health, safety and welfare had not always been assessed and remedial action had therefore not been taken. We were not provided with evidence during our visit that the provider had taken full account of published guidance from the health and safety executive regarding risk of falls from windows or balconies in health and social care settings. Some action to reduce risk was taken during our visit.

Is the service effective?

People we spoke with indicated that they were generally happy living at the home. One person told us, ��I feel alright here, I don�t see anything bad.� Another person told us, �Its� nice here.� The majority of relatives we spoke with were positive about the care provided at the home. One relative told us, �We are so grateful to this home for the high quality of care.�

We checked people's care plans and found most of them to be detailed, relevant and up to date. However, in some instances we found that information to support staff in managing people�s behaviour was not sufficient. This meant that some people were at risk of receiving inadequate or inappropriate care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. People were generally positive about the staff who supported them. One person told us, �The staff are all very nice and helpful.� Another person told us, �We have very nice staff.�

The home employed two activity co-ordinators. We found that people were given the opportunity to participate in a number of activities and organised events at the care home.

We spoke to staff who had recently started working in the home. Staff confirmed that they had an opportunity to complete �shadow� shifts when they first started and had worked alongside experienced staff. Some staff who had worked at the home for some time told us that that they felt the training and support for new staff needed to be improved.

Is the service responsive?

During this inspection we identified a number of issues about which the provider took immediate action to rectify or improve the situation. At our last inspection in January 2014 we had identified that the home was not meeting the regulation in regards to the management of medication. At this inspection we found that this regulation was still not being met.

There was evidence that some learning from incidents took place and appropriate changes were implemented. We followed up on two incidents and found that actions had been put in place to help reduce the risk of future similar incidents occurring.

We found that records were kept of accidents, the number of falls and admissions to hospital. There was no central log of all incidents and medication errors. We were told that this information would usually be kept within people�s individual records. This meant it would be difficult to track the number of incidents occurring and actions taken in response. It also did not enable the provider to complete a full analysis in order to identify any reoccurring patterns or trends.

People's views about the care they received were sought through meetings and questionnaires and relatives and visitors were asked to comment about the service. We saw that completed questionnaires showed that people using the service and relatives were mostly positive about the care they received and these results were available for people to view in the reception area. Where a minority of negative comments had been received there was no information included about the home�s response. This meant that people may be unsure if their comments would be acted on.

Is the service well led?

The service has a quality assurance system, but this had not always ensured that areas that needed improvement had been identified and appropriate action taken.

Systems were in place to assess and monitor the quality of the care provided but some of the concerns we identified during our inspection had not been recognised by the provider.