18 November 2016
During a routine inspection
We undertook this inspection to check that the provider had followed their action plan in relation to breaches of regulations previously found at our inspection in 28, 30 July and 4 August 2015 regarding the provision of person-centred care, safe care and treatment and staffing. The provider sent a plan after this inspection setting out how they planned to address these issues. We conducted this inspection to check that improvements were being sustained in accordance with the provider’s latest action plan and that issues had been addressed. We also followed up on concerns we received information about in relation to staff training and the management of falls.
Peter Shore Court provides care and accommodation for up to 42 older people, most of whom are living with dementia. There were 38 people using the service at the time of our inspection.
A registered manager was not in post. 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. A new manager had been appointed and was working at the service. They had sent their application to the CQC and this was in the course of being processed.
At our previous inspection we found the service was in a state of transition. We found the provider had plans for improving the service, but the high turnover of staff and managers had prevented these from becoming fully embedded in daily working practices. At this inspection we found that whilst considerable improvements had been made, there were still some areas for improvement which needed to be addressed. The manager and deputy manager for the service were clear about what these were and had plans in place for achieving these. They had only been at the service for a few months and had achieved substantial improvements in a short period of time.
Staff responsible for medicines administration had completed medicines administration training within the last year. We received a complaint about the adequacy of staff training in relation to medicines administration. At our inspection we found the training to be thorough and staff were clear about their responsibilities.
At our previous inspection we found there were some gaps and contradictions in care plans. At this inspection we found care plans still contained gaps and contradictions because they were not updated regularly. However, we did not see any examples of this culminating in the wrong or unsafe care being provided for people because healthcare records from multi-disciplinary teams were up to date and care staff were aware of the changes to people’s needs.
We also looked into a complaint received about the management of falls at the service. We found that falls were managed appropriately and preventative measures were put in place where appropriate.
At our previous inspection we found care staff did not always know who was subject to a Deprivation of Liberty Safeguards (DoLS) authorisation and how this affected their care. At this inspection care staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005 and knew who was subject to a DoLS authorisation and what this meant.
At our previous inspection we found some examples where there was a lack of staff engagement with people using the service. At this inspection we found care staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.
People using the service and their relatives told us they were involved in decisions about their care and how their needs were met. However, people’s care plans did not always reflect their needs and wishes.
At our previous inspection we found there were insufficient staff to meet people’s individual needs and there was an over reliance on agency staff. At this inspection we found there were enough staff working to meet people’s needs. Whilst there were still numerous agency staff in place, we found the agency staff working at the service had been working there for a period of at least three months and when questioned, they demonstrated that they knew people well.
Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role and agency staff attended the same induction training as permanent staff before starting work. Staff were provided with appropriate training to help them carry out their duties.
At our previous inspection we found care staff did not attend regular supervision sessions with their line manager. At this inspection we found care staff received regular supervision and they told us they found this useful to their role.
People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met.
At our previous inspection we found there were concerns relating to the maintenance of people’s nutritional and hydration needs. At this inspection we found that whilst there were no issues in ensuring that people’s nutritional and hydration needs were met, care plans did not include enough consistent detail about what people’s needs were in the form of advice and examples about the type of food they should be eating.
People were supported effectively with their health needs and were supported to access a range of healthcare professionals. Healthcare records contained an up to date record of what people’s current healthcare needs were, but these were not incorporated into people’s care plans.
People using the service and staff felt able to speak with the manager and deputy manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place. Records indicated that complaints were dealt with in line with the complaints policy to people’s satisfaction.
At our previous inspection we found there were some issues in relation to the provision of a consistent timetable of activities. At this inspection we found people were encouraged to participate in activities they enjoyed throughout the day. These were both organised, scheduled activities and impromptu activities. A daily activities programme was in place and this included a mixture of one to one sessions and group activities.
The organisation had systems in place to monitor the quality of the service, but these were not always used to full effect. As a consequence issues regarding inconsistencies in the care plans were not addressed. Feedback was obtained from people through monthly residents meetings and a feedback survey was in the process of being disseminated at the time of our inspection. There was evidence of auditing in many areas of care provided as well as monitoring from the local authority contracts monitoring team.
We found one breach of the regulations in relation to good governance. You can see what action we asked the provider to take at the back of the full version of this report.