1, 12 September 2014
During an inspection looking at part of the service
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well-led?
This is a summary of what we found-
Is it safe?
The delivery of care did not ensure people's safety. Staff action when people experienced a fall was not consistent and placed people at risk of further injury. Staff did not always follow the direction of health care professionals, and did not to seek medical assistance when this was required. Care plans did not reflect people's current needs and failed to include detailed instructions to staff on how to support people in a safe manner. Risks to staff and people using the service were not identified, assessed and managed due to no auditing system. Fire evacuation plans were not in place for all people living in the home, and where they did exist these contradicted information in the person's care plan.
The home was not clean and staff practice did not ensure people were protected against the risk of infection. Medicines were not managed and administered safely. Recruitment processes were not sufficiently robust to ensure staff employed in the home were suitable to work with vulnerable adults. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to recruitment. We have also asked them what they are doing to meet the requirements of the law in relation to ensuring care is delivered safely, people are protected from risk of infection, and medication is managed safely.
Staff were aware of what constitutes abuse and the signs that this may be happening. They were aware of how to report concerns and how to escalate these if they were not dealt with appropriately. People we spoke with told us they felt safe living in the home. One person told us, 'I have no problem at all with any of [the staff]'.
Is it effective?
Care plan reviews had not identified where assessments were out of date, contradictory, or information was missing. Care plans for two people could not be located.
Staff completed training but did not put this into practice in the home. Staff had received training in infection control. However, we observed poor practice in the home which placed people at risk of infection. Staff did not complete a competency assessment following training in the administration of medication.
Is it caring?
Staff talked to people in a friendly manner. One person said of the staff, 'they are lovely, very kind'. However, the provider and staff did not always act in a way that protected people's right to privacy and dignity. People, and their relatives, were not involved in the planning of their care. Staff appeared to communicate well with some people and not with others.
Is it responsive?
The service was not responsive. The provider failed to ensure people with specific needs were cared for appropriately. The diet of people with low Body Mass Index (BMI) or diabetes, for example, was not effectively monitored and provided according to specific dietary needs. There were insufficient staff to provide people with the support they required to eat sufficient amounts.
Is it well-led?
The service is not well-led. The provider had not taken action following the serious concerns we found during our inspection in June 2014. Issues with food and nutrition, care and welfare, infection control and quality assurance, staffing levels and staff training had not been addressed adequately. No audits or monitoring of the quality of the service provided was carried out.
A clear management structure was not in place and staff did not receive effective supervision. The provider appeared to be unfamiliar with the requirements of the regulations governing the provision of the regulated activity. The responsibilities of the provider and manager were not clearly defined and therefore concerns that had been identified had not been addressed.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of the service they provide.