This inspection took place on 24 October and 1 November 2016. Both days of inspection were unannounced which meant the registered provider and staff did not know that we would be attending.
We previously inspected the service on 13 and 14 November 2014 and found that the service was not meeting all of the regulations which we inspected. We found the service was not meeting the regulations for consent to care and treatment and good governance. This was because the service did not have suitable arrangements in place for obtaining consent. The service had not been following the principals of the Mental Capacity Act 2005 and this had not been picked up by the quality assurance measures in place at the time. There were also gaps in the quality assurance systems in place at the service. We noted that audits had regularly highlighted the same areas for improvement and actions plans had not been put in place following these audits. The registered manager was not given feedback following these audits which meant they had been unable to make the changes needed.
After the inspection on 13 and 14 November 2014, the registered provider supplied an action plan to show us the action they planned to take to improve the quality of the service.
Mandale care home is registered to provide accommodation for people who require personal care, treatment of disease, disorder and injury and diagnostics and screening for up to 57 older people including people living with a Dementia. At the time of inspection there were 46 people using the service who were supported by 39 staff, of which 28 were care staff. The service was located in a residential area within its own grounds and had on-site parking. The service was located close to local amenities and a short distance from the town centre.
The registered manager had been registered with the Commission since 13 January 2013. 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.
At this inspection, we could see that the service had listened to the feedback provided to them during the last inspection and had made improvements to the quality of the service.
Staff showed they understood the procedures which they needed to follow if they suspected someone was a risk of abuse. Staff were able to discuss the types of abuse which people could be at risk from and how they could help to minimise these risks. All staff spoken with told us they would not hesitate to whistle blow [tell someone such as the registered manager] if they needed to.
Risk assessments were in place regarding people's specific needs and for the day to day running of the service. These were fully completed and had been regularly reviewed. Staff understood the importance of these to keep themselves and people using the service safe.
Health and safety certificates were up to date and showed measures were in place to ensure the safety of people and staff.
All staff had a Disclosure and Barring Services check in place. DBS checks help employers make safer decisions and prevent unsuitable people from working with vulnerable client groups. People and staff told us there were enough staff on duty throughout the day and night to care for them safely. Two relatives thought staffing levels could be increased. We could see staffing levels were regularly monitored.
People received their prescribed medicines when they needed them. From our observations, we could see that people were supported to take them and people were given the time they needed with their medicines.
Staff told us they were supported during their induction period and records confirmed this. We saw staff shadowed more experienced staff whilst they became familiar with people who used the service and the requirements of their role.
All staff were supported to carry out their roles effectively. Staff received regular supervision, appraisal and training. These also included observations of practice.
Staff had increased their knowledge and understanding of the Mental Capacity Act 2005 and Deprivation of Liberties Safeguards (DoLS). Most staff were confident when we spoke with them and felt able to seek further support from the registered manager if they needed to. We noted that not all MCA were decision specific. The operations manager told us they were already aware of this and support was in place to address this and to support staff to increase their knowledge and understanding of MCA.
Staff understood the action they needed to follow to ensure people received adequate nutrition and hydration. Risk assessments and care plans were completed and updated when people became at risk of malnutrition or dehydration and worked alongside health professionalsHowever food and fluid balance records were not up to date. We informed the operations manager and registered manager about this and were assured that action would be taken to address this. .
People told us they had access to health professionals when they needed them. We found evidence of this during inspection from our discussions with people and staff, from our observation of visiting professionals and from the care records.
People and their relatives spoke positively about the care and support they received from staff and told us they enjoyed living at the service. People told us they felt well cared for.
When we spoke with people they were not sure if they were involved with developing and reviewing their own care. We noted that people had not routinely signed their care plans to show they consented to the information in them. People told us that staff always sought their consent before any care and supported was delivered and that they were happy with the care provided to them.
People told us their privacy and dignity was maintained at all times. We observed staff knocking on people’s doors and waiting to be invited in. People were also given the time and support needed at mealtimes and when medicines were dispensed. All of which was carried out in a dignified manner.
People had care plans in place which reflected their health and well-being needs and had been regularly reviewed. We identified some gaps in these records.
We heard mixed reviews about the quality of activities provided at the service. The operations manager and registered manager told us they were both aware of this and plans were already in place to address this.
People and their relatives told us they knew how to make a complaint and felt confident that action would be taken. We could see a small number of complaints had been made and records detailed the action taken to resolve the complaint and the outcome of the complaint.
All staff told us they enjoyed working at the service and felt supported by the registered manager. People and their relatives spoke highly of the registered manager too. During inspection we saw staff worked as a team and regularly communicated with one another.
The service had good links with the local community and people attended events within the community. The local community were also invited into the service for events; these included open days, fundraising activities and visits from local schools.
The service regularly reviewed all accidents and incidents. This meant the service could identify any patterns and trends and take the action needed to minimise the risk of reoccurrence and harm to people.
The registered provider regularly visited the service and carried out quality assurance monitoring. The registered manager also completed a range of audits and developed action plans were any improvements where needed. These were reviewed by the registered provider during their visits.
Staff and people told us they were kept up to date with any changes or events occurring at the service and minutes were available if they had not been able to attend any meetings. We could also see that people had access to regular newsletters and had been invited to participate in the latest survey.
We found staff understood the requirements of their role and worked under the guidance of the registered manager to ensure people received safe care and support. We observed the staff team worked well together and communicated well.
Notifications had been submitted to the Commission when required to do so.