20 June 2016
During a routine inspection
The service had a registered manager. 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. The registered manager was not available on the first day of the inspection. However we were assisted by the general manager and the registered manager on the second day of the inspection.
At our last inspection of this service on 17 and 24 October 2014 we found breaches of legal requirements in relation to people’s care and welfare, mental capacity assessments, dignity, complaints and clinical governance. Following the inspection the provider wrote and told us they planned to meet the requirements of these regulations by 31 March 2015. Since that inspection the provider of the service has changed their name.
People told us they felt safe in the care of staff. People were safe as staff understood their roles and responsibilities in relation to safeguarding. Safeguarding alerts had been made to the relevant authority as required to ensure people were safeguarded against the risk of abuse.
Potential risks to people had been identified and assessed; where required people had plans in place to manage risks to them. If people experienced a fall then appropriate monitoring was completed afterwards to ensure their safety. Required actions were taken to minimise the risk of re-occurrence for people.
The provider had a contingency plan in place which staff followed when a power cut occurred during the inspection to ensure people’s welfare and safety.
People told us there were enough staff to meet their needs. Records demonstrated there were sufficient staff rostered to meet people’s needs safely. Appropriate recruitment checks had been undertaken in relation to staff to ensure their suitability to work with people.
People’s medicines were managed safely by trained and competent staff. There were processes in place to acquire, store, administer and dispose of medicines safely for people.
People told us staff sought their consent in relation to their care. Where people were deprived of their liberty legal requirements had been met. There was evidence staff had correctly completed Mental Capacity Act 2005 assessments and best interest decisions for people. However, staff had not ensured legal requirements were always followed in relation to obtaining people’s consent for the use of bed rails. The registered manager took swift action to ensure this was done for people; however, this practice needed to be embedded and sustained over time.
People told us their experience was that staff were well trained for their role. Staff underwent the industry standard induction and received regular supervision in their role. Action was being taken to ensure all staff were up to date with their required training; however, this needed to be embedded and sustained over time.
Risks to people associated with eating and drinking had been identified and where people were at risk from malnutrition or dehydration guidance was in place to enable staff to manage these risks to people effectively.
Staff arranged for people to be seen by a variety of health care professionals as required to maintain their health.
People told us the staff were nice. There was good interaction and communication between people and staff. Staff treated people with consideration and respect. They ensured people’s dignity was maintained during the provision of their personal care.
People were provided with the information they needed about the service. People’s preferences about their care had been recorded and people could make choices about their care.
People’s complaints had been dealt with in accordance with the provider’s policy and the appropriate actions taken to address these for people.
The activities co-ordinator had sought peoples’ feedback on what activities they wanted and based the activities programme on their wishes. Staff ensured people who were cared for in their bedrooms were not socially isolated. People were encouraged to maintain their independence and to see their families regularly.
Staff had access to information about people’s care needs and their personal history, although some people’s records lacked detail. Staff spoken with demonstrated a good understanding of people’s needs. People’s care plans were regularly reviewed but it was not always easy to identify in peoples’ records when they had last been involved in a review of their care and the level of their involvement. Action was being taken by the provider to address this for people.
There were processes both within the service and externally to monitor the quality of the service provided and to drive service improvement. If any improvements were required these were documented on the service improvement plan and action was taken to address the issue for people.
People and staff told us there was good leadership of the service. There was a clearly defined senior management structure and management at all levels of the service were visible and accessible to people and staff.
The service had an open and transparent culture where staff were encouraged to speak out about any concerns they might have. People’s care was underpinned by a clearly defined set of values which staff applied in their work with people.