The inspection took place on 17 and 22 December 2014 and was unannounced. The inspection visit on 22 December was undertaken during the evening.
The service was last inspected on 31 July 2014 when it was found to be in breach of a number of regulations which relate to people’s care and welfare, quality assurance, record keeping and staffing. We asked the service to take urgent action to improve the care and welfare for people and we checked this at an inspection carried out on 26 September 2014. We found that improvements had been made but we still remained concerned about some aspects of people’s care and welfare and so we set a compliance action and asked the provider to send us an action plan outlining how they intended to continue to improve.
At this inspection we checked to see if the service had carried out the required actions to bring about improvements in the service. We found that there was evidence of improvement but that some further improvements were required
The service provides accommodation and nursing care for up to 60 people, some of whom are living with dementia. At the time of our inspection there were 27 people resident. The service is divided into four almost identical wings. Only three were being used and each unit led on to a communal area with a café and other communal facilities.
The service has had a number of managers since it opened in June 2014 but has not had a registered manager in post since September 2014. 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. The current manager is temporary and will remain in post until a permanent manager is appointed.
We found that staffing levels meant that sometimes people were left without the staff support they needed.
Medicines were managed well for most people but we were concerned that some errors had not been noticed or investigated by staff. We also found that medicines were being given to people later than their prescribed times which could have placed people at risk.
Staff were trained in safeguarding people from abuse. We found that some potentially harmful substances were accessible to people living with dementia. Other risks were assessed and action taken to reduce the risks to the people who used the service. The recruitment process included checks which aimed to make sure that staff could be employed without posing a risk to people.
Staff received the training they needed to carry out their roles and new staff received an induction. Some staff demonstrated an in depth knowledge of the people they were supporting and caring for while others did not.
We saw that staff demonstrated that they understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards DoLS) and acted in accordance with them. The MCA ensures that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.
People who used the service were very positive about the food and were able to exercise choice about their meals. Special diets were well catered for but we some people did not get the support or prompting they needed to eat their meals. People identified as being at risk of not eating enough were promptly referred to the dietician and monitored. People were also supported to access other healthcare professionals when they needed them.
We found the majority of staff to be caring and committed. People were treated respectfully but people were not always encouraged to be independent or involved in the daily life of the service. People, and their relatives, were unhappy with the lack of things to do and were not supported to follow their own interests and hobbies..
People, or their relatives, were involved in assessing and planning care and had opportunities to meet with staff and review progress.
Formal complaints were managed well but some people found the response to concerns which were raised informally less so
The manager had begun to try to change the culture of the service and had introduced some new initiatives and had improved communication. People were confused due to the large amount of changes in management since the service opened. Most of the people who used the service did not know who the new manager was and had not had formal opportunities to meet with her. Quality assurance systems had not picked up some of the concerns we found on inspection.
We found continued breaches of regulations which relate to record keeping and staffing, as well as a breach of regulation which concerns the management of medicines. You can see what action we have told the provider to take at the back of this report.