One inspector conducted this inspection. We used a number of different methods to help us understand the experiences of people using the service. We spoke with three people who lived at the service, five staff members, two relatives, a visiting healthcare professional and a visiting social care professional. We also looked at the care records of four people. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; 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
Is the service caring?
Our observations showed that people had a positive experience of their care and appeared happy, settled and relaxed. They were provided with the support they needed from staff. Staff treated people with respect. We saw that staff addressed people by the name they preferred and used respectful language in conversations with people. Staff created a relaxed and pleasant atmosphere, for example, we saw staff engaged people in conversation using humour which people appeared to enjoy. We saw that staff approached people in a kind way. Staff used touch in an appropriate way to provide warmth and reassure people who were distressed.
People we spoke with were positive about the care they received. Comments included 'The staff are like angels'. Relatives we spoke with were happy with the care their relative's received. Comments included 'The staff are very kind', 'They give them a cuddle and a kiss'.
Is the service responsive?
We saw that people's needs were assessed before they moved into the service.
We saw that the brakes on one person's wheelchair were ineffective at keeping it steady. It moved away from the person being supported into it. We spoke with the staff member involved who told us it was the first time this had happened and they reported such matters to the manager. We saw that they did this and records showed that the brakes were repaired that day. While waiting for the wheelchair to be repaired, two staff supported to the person to transfer into the wheelchair, ensuring it was steady and another wheelchair was also used.
There was evidence that staff responded to incidents that took place and appropriate changes were implemented.
Is the service safe?
Appropriate arrangements were not always in place in relation to the recording of medicine. The system used to record when staff administered medication was not always used effectively. There was no system in place to monitor this effectively.
We saw that there was a gap in an entry on one person's chart used to record when they were given medication. The manager checked and told us that the person was given their medication but the staff member had not signed the record confirming this. Staff had not reported this to the manager. People were not always protected against the risks associated with medicines because the provider did not always have appropriate arrangements in place to manage medicines.
There were systems in place to monitor health and safety within the service. These checks included water temperature checks and fire safety checks.
There were arrangements in place to deal with foreseeable emergencies.
Is the service effective?
There were enough staff on duty to meet people's needs effectively. People we spoke with were positive about the care they received. Comments included 'The staff are quite pleasant. They will always listen to you'. Relatives we spoke with were happy with the care their relative's received. Comments included, the service was 'Absolutely marvellous', 'The staff are very kind', 'They are very nice to [their relative]'. One relative told us that their relative was 'rejuvenated' from the care the staff had provided.
Staff ensured people's privacy and dignity was upheld. One person we spoke with told us that staff always asked their permission before entering their bedroom. One relative we spoke with told us that their relative was 'Always nice and clean and covered'. We saw that people appeared well groomed and during the inspection some people had their hair done by a visiting hair dresser.
People were supported in promoting their independence. We saw that two people's care records showed what personal care tasks they were able to complete for themselves. One staff member we spoke with knew the abilities of one of these people and told us how they provided support to ensure their safety while promoting their independence.
People were given opportunities to participate in activities they enjoyed. We saw one person knitting, another person sat out in the garden, and other people spoke with visitors.
People's health needs were met and we saw that people's appointments with health professionals were recorded. We spoke with a visiting health care professional and they told us that the staff were 'Helpful' and looked after people well. They followed instructions they gave them about managing one person's pressure area on their skin. They added that 'It is a good home'.
Is the service well led?
There were systems in place to monitor the quality of service delivery. These included meetings with people who lived at the service and their relatives. Surveys provided to people and their relatives. There was a system in place to provide staff with the opportunity to feedback about the service. Staff meetings were held and one staff member we spoke with told us that these meetings were useful to discuss people's needs and any concerns.
We saw that there was a complaints process in place and there were systems in place to monitor staff training and competency.