17 January 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 27 November 2018 and was unannounced. The inspection was carried out by one Adult Social Care inspector.
Prior to the inspection, the provider completed a Provider Information Return (PIR). This is a form which gives key information about the service, what the service does well and any improvements they plan to make. We also looked at the notifications we had received from the service. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales. We reviewed other information to help inform us about the level of risk for this service. We considered this information to help us to make a judgement about the service.
During the inspection we spoke with three people living at the service. We spoke with three members of staff, as well as the registered manager. After the inspection we received feedback about the service from three family members and two health and social care professionals who were involved with the service.
We looked at four care records and the medicines administration records for everyone living at the service. We looked at two staff files, and staff training records. We also looked at a range of records and documents including meeting minutes, policies, audits and environmental reports.
17 January 2019
We undertook an unannounced inspection at Admirals Rest Care Home on 27 November 2018. The last inspection of the service was carried out on 7 October 2017. At that time, we identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Shortfalls related to safeguarding people and obtaining their consent, staff training and pre-employment checks. Audits did not always identify the shortfalls found during the inspection.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve in specific areas. At this inspection, we found that necessary improvements had been made.
Admirals Rest is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Admirals Rest is registered to provide care for up to five people with mental health needs. At the time of our inspection there were five people living there. Admirals Rest is situated in a large terraced house close to the centre of Bridgwater. The communal areas of the service were all on the ground floor. This included a lounge, dining area and kitchen. Bedrooms were available on all floors, and most bedrooms were en suite.
There was a registered manager employed at the service. A registered manager is a person who has registered with the Care Quality Commission 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.
People and their relatives were complimentary about the service, the care received, and the staff team. People were asked for their consent and were supported respectfully.
Staff had received training in safeguarding, and knew what they must do to protect people from abuse or neglect. Systems and processes were in place to protect people from harm and to support staff and the provider had made safeguarding referrals to the local authority appropriately.
The provider ensured that there were enough staff to meet the needs of people, and followed effective recruitment procedures to ensure prospective staff were suitable to work in the service.
There was regular monitoring of fire safety, infection control, incidents and accidents as well as regular equipment checks and maintenance. This ensured the premises and equipment were safe, and risks to people were minimised.
People's medicines were safely ordered, received, stored and disposed of, and were administered as prescribed. Medicines administration records were accurate and clear. Some staff required medicines training or updates.
People were supported to make sure their health and wellbeing needs were met. People’s care records contained personalised risk assessments. These gave staff information about how to support people and ensure risks were managed effectively.
Care records described how people wished to be supported and some personal preferences. People were encouraged to be involved in planning their care and treatment. Where appropriate, relatives told us that they were consulted with and informed about people’s care.
Systems were in place to monitor and review the quality of the service. Audits were up to date, but some were brief. In these cases, the information recorded did not support the provider to make effective quality improvements.
The staff team had recently changed and some staff were new to the service. An induction programme was in place, although staff gave mixed views about this. Staff were caring and patient, and most knew people well. Most staff told us that they received relevant training and support to equip them to carry out their duties effectively.