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Inspection report

Date of Inspection: 26 September 2014
Date of Publication: 4 November 2014
Inspection Report published 04 November 2014 PDF | 76.15 KB

Overview

Inspection carried out on 26 September 2014

During an inspection to make sure that the improvements required had been made

We last inspected this service on 31 July 2014 and found that people’s needs were not being met and that poor care practices had placed people at risk. We had particular concerns about the care for people who had a diagnosis of dementia and those with diabetes. We took enforcement action which required the service to improve the way it provided care and support to people and gave a deadline for them to achieve this. The service submitted an action plan to us which outlined how they would ensure the required improvements were made. We returned at this inspection to check that improvements which related to people’s care and welfare had been made. At this inspection we found that there was evidence of some improvement to comply with the warning notice we had issued but some concerns still remained.

Before our inspection we also received information of concern regarding how the service managed people’s medicines. We followed this up to make sure that people received medication safely and in a way that met their needs.

During our inspection we spoke with four people who used the service, eight relatives, eleven members of staff, the support manager and the regional manager. We carried out a structured observation and observed staff providing care and support on two of the units, including the nursing unit. One unit was closed to visitors as a part of an infection control procedure and so we did not inspect there. We also looked at the care records for five people. Other records we reviewed included staff files, medication records and quality and monitoring records. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is the summary of what we found:

Is the service safe?

We found that medicines were being managed in a way that kept people safe. Care plans for people with diabetes had been improved and staff were more knowledgeable about caring for people with this condition. We were concerned that low staffing numbers and the use of agency staff who were not familiar with people's needs placed them at potential risk.

Is the service effective?

We found improvements had been made with regard to the care plans for people with diabetes and the completion of food and fluid charts, although some people were still not reaching the agreed target set for fluid intake. We were concerned that there was still little in the way of leisure opportunities for people. We were also concerned that the numbers of staff on the nursing unit, and at times on the dementia unit, did not meet people’s needs. The needs of people who used the service were documented in their care plans but sometimes information was not easy for staff to locate and did not contain all the information they needed to support people effectively.

Is the service caring?

People we spoke with told us they were happy with the care they received. One person told us, "They look after me excellently - everybody's very nice". Relatives told us that although they had concerns about the numbers of staff they found the staff to be kind and very caring.

Is the service responsive?

People who used the service and their relatives told us they sometimes had to wait a long time for staff to help them with personal care. We found that the service did not always update people’s care plans promptly when there had been a change in their needs.

Is the service well led?

It was clear that the management of the service had made improvements with regard to the monitoring and auditing of care plans and medication. We remained concerned about the lack of management strategy to address the lack of staff at critical times.