This inspection took place on 19 May 2016 and was unannounced. Karuna Manor is a care home registered to provide accommodation for people who require nursing or personal care. They are registered to provide care for a maximum of 60 people who may be living with dementia. There were 21 people using the service at the time of our inspection. This was the first inspection for Karuna Manor since their registration in March 2015.There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
On the day of the inspection we observed that people were well cared for and appropriately dressed. People who used the service said that they felt safe in the home and around staff.
Relatives of people who used the service and care professionals we spoke with told us that they were confident that people were safe in the home.
People were not adequately protected from the risks of unsafe medicines management. Medicines records were not kept up to date so we could not be certain that people were adequately protected from the risks of unsafe medicines management. We found a breach of Regulations in respect of this.
On the day of the inspection staff were not rushed and were able to complete their tasks. However, feedback from people, relatives and staff indicated that at times, there were not enough staff in the home to care and support people safely. This could risk people receiving inconsistent and inappropriate care.
Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.
People's care needs and potential risks to them were assessed. However there was limited information about the moving and handling needs of people using the service and the safety of bed rails in the home. We discussed this with he registered manager who told us he would ensure all the bed rails were checked and appropriate training would be provided to staff. He also told us risk moving and handling risk assessments for people would be reviewed.
Staff prepared appropriate care plans to ensure that people received safe and appropriate care. Their healthcare needs were closely monitored and attended to. Staff were caring and knowledgeable regarding the individual choices and preferences of people.
There were records of essential inspections and maintenance carried out at the home. The service had an infection control policy and measures were in place for infection control.
Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.
People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes.
People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly by staff and were updated when people's needs changed. However, there were some gaps and inconsistency in the monitoring of people’s care on a daily basis.
Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.
The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary applications for DoLS as it was recognised that there were areas of the person’s care in which the person’s liberties were being deprived. Records showed that some authorisations had been granted and some were awaiting approval from the local authority.
People’s spiritual and cultural values were fully respected and accommodated. The home provided vegetarian food in accordance with people’s culture. People were able to watch Indian programmes on television. Care staff were able to speak in Hindi and Gujarati which meant they were able to effectively communicate with people using the service. There was a Mandir (Hindu Temple) on the ground floor and people were supported and assisted to do their prayers and Bhajan (hymns) in the morning.
Staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.
There was a management structure in place with a team of care staff, nurses, kitchen and domestic staff, admin manager, registered manager and the provider. A clinical services manager had also been recently recruited. Staff had a positive attitude and were of the opinion that the service was well managed and the registered manager was supportive and approachable.
There were some quality assurance processes in place to assess and monitor the quality of service being provided and action had been taken. However, there was no effective evaluation of the issues identified. During this inspection, we found further concerns which demonstrated the current systems in place were not robust enough to assess, monitor and improve the quality and safety of the services being provided to people. We found a breach of regulations in respect of this.
We made two recommendations about moving and handling and seeking advice and guidance from a reputable source about adjustments required to meet the needs of people living with dementia.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered manager to take at the back of the full version of this report.