This inspection took place on 5 May 2015 and was unannounced. The service provides care and support for up to 60 older people some of who may be living with dementia. On the day of our inspection there were 54 people who lived at the service.
There was 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.
People were protected from harm because staff knew how to protect them from abuse. We found that when staff reported abuse the registered manager took action. They worked with external agencies to ensure people were kept safe from harm. The provider had learnt from incidents and measures were put in place to reduce the likelihood of these incidents from happening again.
People’s individual risks were assessed and monitored. Where action was required to keep people safe from risk, staff were aware of this and what steps were to be taken to reduce the risk.
However, our findings from this inspection identified that there were insufficient staff to meet people’s needs. People did not receive care, treatment and support that was individual to them. We found that people received care and support based on staff’s requirement rather than the person’s needs. For example, we found three people were distressed and they told us they were frustrated. These people were assisted with getting up, washed and dressed twenty minutes before lunch was being served.
We found that because of staffing levels within the home, some people did not receive their medicines in a timely way, with some people receiving their morning medication 30 minutes before lunch time. The times people received their medication was not recorded to ensure people received their medicines with sufficient time’s in-between doses. However, we found the storage and management of medicines was done so in a safe way.
People who we spoke with felt that staff were knowledgeable about how to care for them. Staff told us they received training and this benefitted them in their roles. For example, staff knew why a person who was at risk of dehydration needed their fluid intake to be monitored and recorded. They used this information to ensure the person was drinking enough fluids to keep them healthy.
We found that people and where necessary, their family members, were sought for their consent in line with their care. We found these wishes were respected by staff and staff recognised the importance of this. All staff we spoke with were aware of people’s human rights and how this could be affected for people who may lack capacity. We saw that mental capacity assessments had been carried out where people were not able to make decisions themselves. We found that families were involved in making best interest decisions about the person’s care. However, we found that while the provider recognised that some people had their freedom restricted; this was not done so in a legal way. As the provider had not submitted the applications to the supervisory body in order to gain the correct permission.
We found people were supported with enough food and fluid to keep them healthy. We found that people had access to healthcare professionals, such as optician, dentist and their doctor when they required them.
People and relatives told us they felt listened to and were an active part in developing their care. However we found this was not always the case. People’s views and decisions they had made about their care were not always listened and acted upon. For example, people were not able to have a bath or shower when or as often as they would have liked. People told us that they would have to “book a bath” so that staff were available. One person told us that prior to coming to live in the home they would bathe every day, and now they were only able to bathe once a fortnight. During our inspection we found the communal bathrooms were used as storage areas for equipment and some baths were dusty. Staff told us that nobody had had a bath that day, but did not know why.
People did tell us that staff treated them kindly, with dignity and respect. People told us that staff respected their privacy, for example, staff would knock on their door and wait for a reply before entering. We saw staff interacting with people and they did so in a kind, caring and sensitive manner.
We found that the decision’s people had made about their care and support were not always met in a responsive way. Some people had to wait to be assisted to the toilet; others were required to wait to receive personal care in the morning while other people received their morning medication half an hour before lunch time. This was not personal to the individual’s choice and did not reflect their wishes.
We found that people knew how to complain and felt comfortable to do this. Where the provider had received complaints, these had been responded to.
The provider did not always demonstrate clear leadership. Staff were not always supported to carry out their roles and responsibilities effectively, which meant that people’s care was sometimes compromised. We also found that lack of communication hindered the effective and responsiveness of the care provided to people.
Our findings did not reflect the provider’s findings, which were largely task orientated roles, such as cleaning schedules. Where shortfalls were identified, effective systems were not always in place to ensure that lessons were learnt and used to improve staff practice.
We found three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.