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Inspection report

Date of Inspection: 18 September 2014
Date of Publication: 20 November 2014
Inspection Report published 20 November 2014 PDF | 105.22 KB

Overview

Inspection carried out on 18 September 2014

During an inspection in response to concerns

We undertook a responsive inspection of Genesis Care Home on 18 September 2014 because we had received information of concern regarding poor safeguarding arrangements for people who lived in the home and low staffing levels (particularly at night) that were putting people at risk from harm.

During the inspection we spoke with seven members of staff. Some were on duty in the home and some we spoke with on the telephone. We also spoke with seven of the people who lived in the home and two of their relatives.

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 safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We had been told prior to our inspection that an incident had occurred where a person who lived in the home had behaved in an abusive manner. We were able to confirm that this had occurred and had not been dealt with in line with safeguarding procedures. We looked at the systems that had been put in place following this incident and were not satisfied that people were being protected from potential harm or abuse. We contacted the local authority safeguarding unit to share our concerns and to ensure that appropriate steps were taken to protect the people who lived in the home.

Prior to our inspection we had received information of concern that told us that staffing levels were very low at the home and there were regular times when there were not enough staff on duty to meet the needs of the people who lived in the home.

We asked the deputy manager and they told us that the agreed staffing levels were six staff on the morning shift, four staff on the afternoon shift and three staff on the night shift. We looked at the rotas for the six weeks prior to the inspection and we saw that these staffing levels were often not maintained. We saw that there were regular night shifts that were covered by only two members of staff. We were aware that there were a small number of people living in the home who required two staff to support them with their personal care needs. This meant that if staff needed to support them during the night this left the rest of the building unattended. We asked if a dependency tool was used to monitor and evaluate the changing needs of people to ensure that staffing levels were maintained at adequate levels. We were told that there were no tools used and the staffing levels had been the same for years but were currently not maintained.

Is the service effective?

We asked about staff support and supervision sessions and were told that these did not take place. We looked at the supervision records for 11 staff and saw that only three of them had received one supervision this year and some had never had any supervision sessions. We saw that some appraisals had taken place but that most of these were over a year ago.

We asked about training and staff told us that training did not often take place due to staff shortages. We spoke with one of the senior care staff who was also the home's staff trainer. They told us that training was often cancelled due to time and staff constraints. They were constantly working on the rota which left no time for training.

Is the service caring?

During our inspection we spoke with seven people who lived in the home and two of their relatives. All of them spoke very highly about the staff and the care that they received but significant concerns were raised about staff shortages. People told us that the staff worked very hard to meet their needs. Comments we received included; "I have really good relationships with the staff but they work too hard and never get a minute to chat" and "The staff are very busy and very kind. They do so much for us and they are run ragged and it's not fair on them."

Throughout the day of our inspection we observed staff interacting with people who lived in the home. We saw warm, positive interactions. It was obvious that the staff had very close relationships with the people that they were caring for. We saw that people were treated with dignity and respect and were also having a laugh and a joke with the staff. One person who lived in the home said to us "I love it here. I've acquired a selection of daughters."

Is the service responsive?

Examination of care records showed that care plans had not always been updated to reflect people's current personal and healthcare needs. For example, we saw one person in the home whom we had observed required significant support from staff to meet their personal care and mobility needs and to support them to eat and drink. We looked at their care records and saw that they had not been updated to meet their current needs and had not been evaluated since March 2014. We were concerned as their needs had changed considerably but the records did not reflect any of these changes.

Is the service well led?

During our inspection we were not able to access any audit information as the staff were not aware of where the information was stored. We spoke with the manager the following day and they emailed us the most up to date audits. We saw that the last care plan audits had been carried out in February 2013. We were concerned as the care plans were very poor and the lack of monitoring had contributed to this as regular audits would have highlighted the issues. There were no audits in place to monitor staff supervision or training. Regular monitoring of these would have identified the lack of both taking place for the staff.

We saw that no staff team meetings were taking place and the last meeting for people who lived in the home had been held in December 2013. The activities programme we saw said that a 'resident's forum' took place on a monthly basis but there were no records to evidence that these were taking place.