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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

There should be enough members of staff to keep people safe and meet their health and welfare needs (outcome 13)

Enforcement action taken

We checked that people who use this service

  • Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 18 September 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members and reviewed information given to us by the provider.

Our judgement

There were not enough qualified, skilled and experienced staff to meet people’s needs.

Reasons for our judgement

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.

We spoke with seven people who lived in the home and six of them raised concerns with us about the lack of staff. The person who did not have concerns had only recently moved into the home. They told us that even though they were not concerned, they had been unable to have a bath on their agreed day and had waited an additional two days because of staff shortages. The people who had raised concerns made comments such as; "The staff are very overworked and we need more of them" and "It's like the Marie Celeste at night." All of the people we spoke with stressed to us that they thought that the staff were "wonderful" and "very hard working" but that they felt sorry for them as there was not enough of them.

During our inspection we spoke with seven staff. Some of these staff were on shift and others we spoke with on the telephone. All of them raised concerns about the poor staffing levels and the impact of this on the people who lived in the home and on themselves. Discussion with staff and examination of the rotas confirmed that staff were working very long hours, up to fourteen hour days for days at a time. Some of the staff told us that they liked working extra hours but there was a limit to the number they could work. They also told us that they felt under constant pressure to work the hours because they had a duty to the people who lived in the home and to support each other.

We asked about relief staff and were told that there was one but this person had other commitments and could only work limited hours. We asked about agency staff and we were told that they were not allowed to use any so all additional hours had to be covered by the existing staff team.

Throughout our inspection we walked around all three floors of the building. We saw that floors were often left unattended as there were not enough staff to ensure that there was always a staff member on each floor. There were five staff on duty on the morning of our inspection instead of six. We also noted that the deputy manager was included in these five but that they spent the majority of their time in the office trying to get staff cover for other shifts, ordering medication and answering the telephone.

We saw that two days prior to our inspection, medication training had taken place. We asked how staff had attended this training and we were told that they had been taken off the morning shift to attend. This meant that three staff had been left to cover the needs of 39 people whilst the training took place.

We were also told that there was a problem with staff going off sick in the home, particularly on nights and that the evening staff were often anxious about this because they knew that they would have to stay on and work a night shift when this happened. We could see from the rota