17, 18 July 2014
During a routine inspection
We spoke with six people who use the service and two relatives of a person living there. Also the registered manager, eight staff and three health and social care professionals during the visits.
Records viewed included those relating to quality monitoring, audit and maintenance activities. Also the home's development plan, care records of four people, staff rotas and training records.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and what we observed.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
People who used the service told us they felt safe and secure. Their comments included, "Staff are never far away, they usually answer my call bell promptly unless they are very busy. I can rely upon them to ensure my safety.' Also, 'I am happy with the way staff look after me. I trust them to make sure I am safe.'
Records showed people experienced safe and appropriate care. Their needs had been assessed and their care and treatment planned and delivered in accordance with individualised care and risk-management plans. The needs of people with short-term memory loss had been taken into account through the use of appropriate signage, enabling them to locate their rooms and toilets.
We looked at staff rotas and spoke with staff. The information gathered from these sources showed people received consistent, safe levels of support. This was because sufficient staff were available to meet their needs. We saw the staff were suitably qualified, skilled and competent.
We found people were not protected against the risk of unsafe or inadequately maintained premises. Whilst a system of regular audits was in operation to minimise environmental hazards, action had not been taken to reduce risk to people from a specific hazard. Records stated glass in patio doors was not shatter-proof. This was identified at the time of an incident and recorded in a health and safety audit record. We were told authorisation was awaited for these doors to be replaced. Though we acknowledged maintenance work was ongoing, we found areas of the home unfit for purpose owing to their poor state of repair, for example, bedrooms, a lounge and conservatory. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to ensuring the safety and suitability of the premises.
We found the registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS authorisations were in place or applications made, staff were able to describe the circumstances when an application should be made and knew how to submit one.
Procedures were in place to protect people from abuse. Staff had received safeguarding vulnerable adults training and knew how to respond to allegations or suspicions of abuse.
Procedures were in place for dealing with emergencies and staff were suitably trained to ensure people's safety and welfare.
Is the service effective?
We found that people experienced effective, safe and appropriate care, treatment and support which met their needs and respected their rights.
People's needs had been assessed and individualised care plans produced. These had been written in a person-centred way and focused on the needs and wishes of people or those representing them. Some people told us about their experience of life at the home. Others were unable to do so owing to various conditions affecting their memory and/or verbal communication. Whilst people were unable to recall staff involving them in planning their care, we found they were satisfied with the way staff met their needs. Comments included, 'I am happy here, staff know what I like, they help me dress myself and I do what I want.' 'Staff know how I like things done and listen to me."
We found assessments and care plans to be holistic, addressing people's physical, communication, emotional and social needs. Staff promoted and respected people's diversity, privacy and spiritual beliefs. Examples of this in practice included provision of an optional rice dish accompanying the meal at lunch time as an alternative to potatoes, acknowledging the cultural preferences of individuals. There were arrangements for people to practice their religious beliefs. Staff were observed to respect the dignity of people by ensuring intimate personal care needs were met in the privacy of bedrooms, toilets and bathrooms.
Observations confirmed staff understood people's individual communication methods, enabling choice in their daily lives. Throughout the visits they were attentive to people, engaging them in social interactions as well as stimulating social activities programme. This was found to be underpinned by reminiscence techniques and equipment. Staff respected the rights of people who wished to be on their own and not join in and the preference of an individual to remain in their room. People had a choice of meals and drinks.
Is the service caring?
People who used the service were overall positive about the care they received. When asked for their opinions, comments included, 'It's okay here, I feel looked after alright. Staff are around when I need them.' Also, 'My family think I am in a good place. I am happy with the staff and my care and enjoy the entertainment.' We also spoke with two relatives who visited daily and told us they were very happy with the standard of care at the home and with staff.
People were dressed in clean clothing appropriate to their age and hot weather conditions. Attention had been given to their personal hygiene and grooming. Staff were knowledgeable about people's preferences and attentive to them. We observed high levels of engagement between staff and people and found staff to be caring in their approach.
Is the service responsive?
Visiting professionals told us that the service generally worked well with other agencies, ensuring people received care in a coherent way.
Staff had learned from incidents investigated earlier this year under safeguarding procedures. Though allegations had been unsubstantiated, some shortfalls in practice and record keeping had been identified and had since been addressed.
People or their representatives knew how to make a complaint. The complaint procedure was prominently displayed in the entrance hall next to a suggestion box. Forms were hanging up beside signage inviting visitors to make comments and suggestions. A person using the service told us, 'If I am not happy with anything I tell staff and they always put things right."
Is the service well-led?
We found the home to be well-led.
Systems were in place for monitoring the quality of services. Learning from incidents had been constructively used to promote service improvement and development.
Staff understood their roles and responsibilities. The registered manager provided direction and leadership to the staff team, managing their responsibilities under challenging circumstances. Specifically the home had not had a deputy manager for over five months and had been unable to recruit to this vacancy. Additionally, the administrator left a month ago and had not yet been replaced. This meant that the registered manager had assumed additional administrative tasks including payroll responsibilities. A senior care assistant had assumed additional responsibilities.