The inspection visit was carried out on 07 and 08 May 2015 and was unannounced. The previous inspection was carried out in February 2014, and there were no concerns.
The home provides accommodation, residential and nursing care for up to 22 older people. There were 17 people receiving nursing care and support on the day of the inspection. Accommodation is provided over two floors with a passenger lift between floors.
The service is run by a registered manager, who was not present on the day of the inspection visit, due to being on maternity leave. 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 and associated Regulations about how the service is run. The deputy manager was present throughout the inspection. The registered manager of the provider’s other service in the vicinity was providing additional support while the registered manager was on maternity leave. There was also administrative support from the other service.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The deputy manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). No applications had been needed to the DoLS department for depriving people of their liberty for their own safety.
Staff had been trained in safeguarding adults, and discussions with them confirmed that they understood the different types of abuse, and knew the action to take in the event of any suspicion of abuse. Staff were aware of the service’s whistle-blowing policy, and were confident they could raise any concerns with the deputy manager, or with outside agencies if they needed to do so.
The service had systems in place for on-going monitoring of the environment and facilities. This included maintenance checks, and health and safety checks. Monthly health and safety checks were carried out and identified any new concerns, such as the patio being wet when slippery and needing to be jet-washed. The maintenance staff signed to show when tasks had been completed, but had not dated these records. Each person had general and individual risk assessments in regards to their health and welfare, including a personal emergency evacuation plan. Accidents and incidents were reported and followed up. Actions were put in place to minimise the assessed risks for people.
Staffing numbers provided sufficient staff to care for people effectively. People were confident that there were suitable numbers of staff to provide them with the care and support they needed. People said they felt safe and secure living in the home, and that staff attended to them promptly. People’s comments included, “I feel very safe here, I don't have anything to worry about”.
Robust staff recruitment procedures were carried out, to ensure that required checks were completed, and staff were suitable for their job roles. Staff induction and training records showed that staff were working to appropriate standards and kept up to date with essential training. Staff told us that they received regular individual supervision, every six to eight weeks, and a yearly appraisal. Records showed that staff had received supervision during January – March 2015; but staff were unable to locate regular records of previous supervisions. Records of yearly appraisals were not available. Staff meetings were held, and staff were encouraged to share their views and to take part in the development of the service.
Nursing staff ensured that medicines were stored and administered to people using safe practices. People told us they received their medicines on time.
People and their relatives said that they knew about their care plans, and had signed to consent to the care provided for them. Records showed when discussions had taken place with people and their family members, and the decisions they had made. This included forms for ‘Do not attempt resuscitation’ (DNAR), use of bed rails, and use of other equipment such as a recliner chair. Consent was obtained before taking photographs for people’s identity or for recording wounds or bruises.
People said that the food was good and they enjoyed it. The menus showed that people were provided with choices which promoted a healthy and nutritious diet. People told us that they could request different items than those on the menu if they wished to do so, and said there was always “plenty of food”.
People’s health needs were discussed before admission, and assessments were carried out as part of the admission process. Referrals were made to their GP and to other health professionals as needed. The service contained suitable equipment to support people with their health needs, and this was serviced and maintained for safety. Wound care was managed effectively, but recording processes were unclear where people had more than one wound.
Staff were caring and considerate with people, and treated them with respect and dignity. They were supported in making their own choices about where to sit and what to do. People’s life histories were recorded in their care plans, and this helped staff to understand them more easily and to engage them in conversation about subjects which interested them. People were encouraged to retain their independence where possible.
The service provided individual activities and an entertainment programme. Many people had high nursing needs and were confined to bed or preferred to stay in their own rooms. An activities co-ordinator spent time with people individually, and kept clear records of how people responded to the time spent with them. We observed that staff spoke to people briefly on the way past the bedrooms where people liked to have their doors open, so as to prevent feelings of social isolation.
People said they did not have any concerns but would feel confident in raising any issues or complaints. A copy of the complaints procedure was provided to people when they were admitted to the service and was provided in large print. No complaints or concerns had been recorded for the past year.
Staff were informed about any changes at handovers, and were allocated each day to a specific group of people. Staff were clear about the values of the company, and said they would treat people as they would like their own relatives to be treated. The deputy manager was leading the work in the home during the registered manager’s absence, and was committed to ensuring that staff carried out their duties well and gave appropriate care.
An administrator with ‘Human Resources’ training was in the process of reviewing all of the staff policies and procedures and updating them. However other policies and procedures available were not up to date.
Audits were carried out to assess the on-going progress of the service, including an infection control audit and a health and safety audit. These were appropriately detailed, but had been amended using ‘tippex’ correction fluid, which meant that records could have been falsified.
The service is required to inform CQC of deaths that take place and other incidents. CQC had not received notification of deaths since May 2013, although deaths had occurred since that time.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.