A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service caring, responsive, safe, effective and well-led? Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.If you want to see the evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service caring?
People looked well cared for. When we spoke with people they were complimentary about the care they received from staff, describing them as 'caring' and 'friendly'.
Staff were kind and respectful to people at all times. They were attentive and alert to people's moods and we saw them comforting people when they became distressed or agitated. They demonstrated a good rapport with people, who appeared comfortable in their company, and to trust them.
Staff were knowledgeable about the people they cared for and knew people's likes and dislikes and their preferred care routines. One relative told us that they were very happy with the care their family member received. Prior to our inspection we had received information of concern in relation to inadequate care. We did not find this to be the case on the day of our inspection.
Is the service responsive?
The home provided services for people with a high level of need and records clearly demonstrated how care and support should be provided in line with people's wishes.
There was a system in place to review the dependency needs of people and to change the level of support where required. Likewise, the nursing staff reviewed and monitored people's care and treatment needs to ensure appropriate care was given in response to changing needs.
People's care and treatment was reviewed on a regular basis with them, this enabled people to discuss any changes or preferences regarding their care and support.
People took part in activities if they wished to. The activities co-ordinator consulted with people about their interests and hobbies and the activities they would like to see in the home. This enabled the activities co-ordinator to set up activities according to people's wishes. For people who either preferred to stay in their bed room or were bed-bound, a volunteer visited people in their rooms to offer social interaction, either by chatting or reading to them.
The provider had received two complaints regarding the provision of care and had acknowledged where there had been a drop in standards. The manager had put systems in place to minimise repeat occurrences.
Is the service safe?
The home had appropriate systems in place for the recruitment and selection of staff. The personnel records showed that staff employed to work at the home were suitable and had the skills and experience required to support people living in the home. All new staff completed a Disclosure and Barring Service (DBS) check to ensure that they were suitable and safe to work with vulnerable people.
The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found there were appropriate policies and procedures in place and staff had been trained to understand when an application should be made. Staff understood the importance of enabling people to make safe choices and documents evidenced where people may need support with this.
The home was clean throughout and walkways were clutter free which enabled people to move around the home safely and freely.
Is the service effective?
The home had systems in place to ensure that people received the care they required. The care plans were person centred and demonstrated that people's care and treatment needs had been assessed and were reviewed on a regular basis.
The nursing staff worked closely with other care staff in providing guidance when care and support needs changed which ensured a continuity of care. The head chef liaised with nursing and care staff in devising specialist diets or when dietary needs changed. People said they were happy that they received appropriate care and support.
The housekeeping and kitchen teams received appropriate training and support through a system of supervision and appraisals which enabled them to develop professionally and keep their skills up to date. All staff within the home were offered specific training which was relevant to their role, such as dementia awareness. However, not all care staff received regular formal supervision or appraisal. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.
Is the service well-led?
There were quality assurance processes in place which were monitored externally through the provider. There were audits in place and checks were made regarding the environment, record keeping, infection control, medicines, falls risks and complaints. The home did not have up to date information in relation to staff training or a robust sytem in place for monitoring and responding to changes in staffing levels. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.
People told us they would inform the manager if they had any complaints. One person said 'I have no complaints at all'. There was a clear procedure in place where people or their families could raise concerns and information was available to people regarding the complaint process.
People were asked for their opinion on the service they received through satisfaction questionnaires and the next survey was due towards the end of 2014. Staff were able to discuss concerns directly with the manager or through team meetings. More recently staff had raised the issue of staffing levels with the manager.
Staff said they had a good team and everyone got on well. Many of the staff had been employed at the home for several years. Staff were aware of the structures in place regarding accountability and were confident in their role and responsibilities.
The manager submitted notifications to the Care Quality Commission as required and reported relevant safeguarding concerns to the appropriate authorities.