Archived: Daisy Bank Nursing Home

Is it safe?

During our last inspection on 07 April 2014 we found the service was non-compliant in relation to the consent to care and treatment.

At this inspection we looked at records to assess whether the provider had made improvements to the way that people consented to their care and treatment and how people who lacked the ability to consent were supported to make decisions in their best interests.

We found that there had been some improvements in this area but the provider needed to make further improvements to ensure that appropriate assessments and care records were in place for people who were unable to make decisions about their care and treatment.

Is it well led?

During our last inspection on 07 April 2014 we found the service was non-compliant in relation to the monitoring of the quality of service provision.

At this inspection we found that there had been improvements made to the systems in place to assess and monitor the quality of the service provided. The newly employed manager had implemented systems to ensure that the quality of the service was monitored and where concerns were identified these had been acted upon.

Below is a summary of our finding based on our observations, speaking to people who used the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is it Safe?

Previously we had concerns that people were not safe due to the poor management of their medication. We found that the service had made improvements in this area. Staff told us and we observed that there were enough staff to safely meet the needs of people who used the service.

Is It Caring?

People were observed to be treated with dignity and respect by the staff supporting them. People told us they were happy and well cared for at Daisy Bank. One person told us: 'I have no complaints, it's nice here'.

We saw that people were well dressed and were offered choices. People's care needs were met in a timely manner.

Is it Responsive?

People's health and care needs were assessed but people who used the service or their representatives had not always consented to their care, treatment and support.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in the planning of their care

Is it Effective?

People's health and care needs were assessed and care plans were clear for staff to follow. People received the care they needed at the right times. People's health care needs were met with the appropriate external agencies support.

Is it Well Led?

We had previously had concerns that systems were not in place to ensure a quality service was maintained. The service had recently employed a new manager. They were present on the day of our inspection, with the provider and chief executive. The provider had voluntarily suspended all new placements into the service whilst they made the required improvements to meet regulation 13 and 10 of the Health and Social Care Act. We saw that although some new systems in the form of audits had been implemented they were not yet effective in maintaining and improving the quality of care being provided to people who used the service.

We asked the provider to tell us what they are going to do to meet the requirement of the law in relation to quality assurance.

During this inspection we observed how people received their medicines and found that medicines were administered and stored safely. We found that the provider needed to make further improvements to the way prescribed creams were administered and recorded.

We found that there had been some improvements made to the systems in place to assess and monitor the quality of the service provided. The provider needed to make further improvements to ensure the systems in place were effective and sustained.

We saw that the provider had made some improvements to the care and welfare of people who used the service. People who used the service told us that they were happy with the care provided. One person told us, "I am okay here it is good". Further improvements were still required to meet the required standards of care.

We saw that medicines were not kept securely which placed people at risk of harm. We found that people were not receiving their medicines as prescribed. This meant that the provider did not have appropriate arrangements in place to manage the risks associated with medicines.

We found that the provider had made improvements to the systems in place to ensure that staff received training and support to carry out their role effectively.

We found that the provider had undertaken some monitoring of the service but where concerns had been raised these had not been acted on which put people who used the service at risk of harm.

We have referred our concerns to the local authority for their information.

A pharmacist inspector and a compliance inspector visited the home to ensure that the provider had met the requirements for the safe management of medicines. We looked at the medicine administration records for six people and how the service stored and managed medicines.

We found that appropriate arrangements were still not in place to manage the risks associated with medicine management and the warning notice had not been met.

People who used the service told us they were happy with the care that they received. We spoke with one person who told us, 'The staff are wonderful'. Another person told us, 'The nurses are good they come if I ask them to'.

We found that care plans were not always in place to ensure that staff knew how to meet people's needs. This meant that people were at risk of receiving inconsistent and inappropriate care.

We saw that people's dignity was not always considered when staff provided care to people who used the service.

We found that people were not receiving their medicines as prescribed. We found that appropriate arrangements were not in place to manage the risks associated with medicine management.

We saw that there had been some improvements to the way staff were supported to carry out their role. Staff told us that they had received an appraisal to discuss any concerns and development needs. Further improvements were needed to ensure that staff received suitable training.

We found that there had not been improvements made to the systems in place to assess and monitor the quality of the service provided.

We have also referred our concerns to the local authority for their information.

We saw that people who used the service or their family members were involved in the planning of their care and staff treated people with dignity and respected when providing support. People we spoke with told us that the staff listened to their wishes. One person told us, "staff listen to what I want". A relative we spoke with told us, "I was involved in my mum's care plan and I am invited to the reviews".

We viewed care records that were centred around the individual and the staff we spoke with understood the needs of the people who used the service.

We carried out an audit on the management of medication and found that there were no effective systems in place to safeguard people from the risk of unsafe administration of medicines.

We spoke with staff and viewed training records, which identified that the provider did not have an effective system in place to ensure that staff received adequate training, development and support to undertake their role.

The provider did not have effective systems in place to monitor the quality of the service they were providing to people who used the service.