We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found-
Is the service caring?
People were treated with consideration and respect. We spoke with three people and one person's relative. One person told us, 'The staff are very good. The way we are treated is very good.' Another person said, 'If you don't look very happy they question it.' One person's relative commented, 'The staff have always been very friendly.' We saw that people were treated sensitively. For example, we saw staff kneeling down to a person's eye level and provide reassurance regarding their medicines. The provider may find it useful to note that we observed staff assisting people to eat while wearing disposable gloves. The registered manager told us that this practice was carried out to reduce the risk of infection. However, no specific risks of infection had been identified with helping these people to eat and this practice did not respect the people's dignity.
People's privacy was respected. One person told us, 'The staff will knock on the door before coming in. They always close the curtains when they are helping me.' Another person said, 'The staff knock on the door before they come in. We have enough privacy.' We saw that people were supported with their personal care needs behind closed doors and staff knocked on people's doors before entering their rooms. The provider may find it useful to note that a list of people and the day they had a shower was publically displayed in the home. This did not respect people's privacy.
Is the service responsive?
People could access the services of healthcare professionals as necessary. One person told us, 'The staff phone the doctor if we need them. The district nurses have also been in before.' Another person said, 'They are on the ball here with the doctor. The doctor comes here we never have to go to the surgery. If I ask to see the doctor they get one for me.' A person's relative commented, 'The manager will call the doctor if she needs to. Mum is taken to outpatients appointments by the home.' We found that contacts with healthcare professionals were documented in people's care records, for example, visits by the chiropodist and GP.
Is the service safe?
We looked at four people's care records and found that their needs were not always accurately assessed. For example, people's risk of malnutrition was assessed using a nationally recognised tool. This tool requires the assessor to consider weight loss in comparison to the person's usual weight over a period of three to six months to calculate the degree of risk. None of the assessments we looked at had considered any weight loss over this period and there was no recording of the person's usual or pre illness weight. One person had lost a significant amount of weight in the previous month, however, the assessment concluded that they were at a medium risk of malnutrition rather than a high risk as the assessment had not been accurately completed. This meant that there was a risk that people at risk of malnutrition were not identified.
People's moving and handling needs were not adequately assessed. We looked at people's care records in relation to moving and handling. These records did not demonstrate a sufficient assessment, such as consideration of the type and size of equipment required to assist the person to move safely. The registered manager told us that the hoist slings allocated to people did not have any identifying markings on them as staff could visually recognise each person's equipment. We found that the hoist sling in one person's bedroom was marked with a name of a person who did not occupy the room. Another person had a large sized hoist sling which the registered manager said was due to their epilepsy rather than their size. However, there was no assessment which detailed that this was recommended by a healthcare professional.
People told us that there were sufficient staff to meet their needs. We spoke with three people and one person's relative. One person told us, 'Normally they are very quick when I press the bell.' Another person said, 'I think there are enough staff. They have got short now and again, but they just get on and do extra.' A person's relative commented, 'I've never noticed there being a shortage of staff. As far as I know, when mum presses her buzzer there is no unnecessary delay.'
People's care records did not always contain sufficient information to protect people from the risks of unsafe or inappropriate care.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had made a number of applications under these safeguards.
Is the service effective?
People's risk of skin damage was assessed and care was planned to reduce this risk. We found that an assessment of people's risk of skin damage had been carried out. We found that where people were assessed as being at risk of skin damage a plan was in place to reduce this risk. For example, one person had a pressure-relieving mattress which was set at a level which was consistent with their weight and was regularly checked.
People told us that care was delivered to meet their needs. We spoke with three people and one person's relative. One person told us, 'They always look after me. The staff are brilliant.' Another person said, 'The staff are very nice and very good. They are there to help us and they do help us. You will have to go a long way to beat this place.' A person's relative commented, 'They are meeting mum's needs.' We spoke with three staff who were aware of people's needs.
Is the service well led?
People's views of the service were sought. We spoke with three people and one person's relative. One person told us, 'The manager is very attentive. I see her quite a bit. She is always there if I want her.' Another person said, 'We asked for our supper later, so they now bring it at 9pm rather than 8pm.' We looked at the minutes of two recent 'residents meetings'. We found that people's views were sought during these meetings on a range of topics such as activities and the menu. The registered manager told us that they were preparing a survey for people to complete.
The provider did not have an effective system to monitor the quality and accuracy of people's care records. The registered manager told us that they monitored the quality of people's care records by completing monthly evaluations. However, this monitoring had not identified issues such as the lack of adequate assessment of people's moving and handling needs or the absence of detail in people's repositioning charts.
Audits of practice were not always effective. For example, we looked at records relating to a health and safety audit. The audit looked at moving and handling, among other health and safety topics. The audit stated that the correct size of hoist slings were used and detailed in people's care records. However, we found that this was not the case in all of the people's care records we looked at.
Trends in accidents and incidents were considered on a three monthly basis. We found that the provider had a system to review all accidents and incidents on a three monthly basis in order to identify any trends. We looked at records for the previous six months. No trends had been identified during this period.