12, 16, 17 June 2014
During a routine inspection
We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;
' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found.
Is the service caring?
We saw that people were supported by kind and attentive staff who displayed patience and gave encouragement when supporting people, for example by assisting them with mobility or personal care. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required. People told us that they were happy with the care and support they received from the service. One person said, "I like it here. All the staff are my friends."
People's diverse needs had been recorded and staff were fully aware of people's care and support needs.
People told us and staff confirmed they pursued activities outside of the home regularly. This showed the provider promoted people's well-being.
Is the service responsive?
The provider had arrangements in place to review people's care records regularly and we saw that amendments were made to people's documentation as their needs changed, to ensure this remained accurate and any issues were promptly addressed.
Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as occupational therapists or doctors, or where, for example, their behaviours needed to be monitored, they received this care.
There was an effective complaints system in place and we found that both people and staff felt confident in raising concerns with the manager. Records showed that all previous complaints raised had been handled appropriately.
Is the service safe?
We found that people were treated with respect and dignity by staff. People told us they felt safe and the care that we observed was delivered safely. For example, we saw that appropriate and safe moving and handling techniques were used when staff assisted people with mobility. Risks that people may be exposed to in their daily lives and in relation to their care needs had been considered. We saw that instructions had been drafted for staff to follow to ensure people remained as safe as possible in light of these identified risks.
However, people's care needs were not always met during night time hours as staff slept during the hours of approximately 10pm and 6.30am. Some people had needs which we considered required night time monitoring and their welfare was at risk because this was not available to them. These night time risks had not been assessed by the provider. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to protecting people's care and welfare.
We reviewed the arrangements in place for the management of infection and potential infection. We found that these arrangements were appropriate. Staff were trained in infection control.
We found the building was not well maintained and entry into the building was not secure. People were not accommodated in a safe environment. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining the safety and suitability of the premises.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We discussed the recent Supreme Court judgement handed down on 19 March 2014 in the case of 'P v Cheshire West and Chester Council and another' and 'P and Q v Surrey County Council', about what constitutes a deprivation of liberty. The manager confirmed they had been in contact with their local safeguarding team in light of this judgement, for further advice on their responsibilities and the arrangements they now need to put in place, for people in their care. We saw paperwork that had been sent to the service by the safeguarding team to support this.
Is the service effective?
People told us they were happy with the staff who cared for them and they met their needs. One person said, "I like it here." Another person told us, "The staff help you." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.
People's needs had been taken into account in the layout of the service.
Is the service well-led?
The provider had a range of policies and procedures in place which gave direction and instruction to staff. Meetings for staff and people who lived at the home were held monthly and some audits were carried out regularly, in addition to health and safety checks. However, the provider did not always review the results of these audits and checks, and they did not review the minutes of meetings held within the home. In addition, staff told us that although they understood their roles and responsibilities, they felt unsupported by the provider and detached from the provider's organisation and other services. Staff said they received feedback from the manager whenever they raised concerns or issues but that the provider did not always address issues.
A limited quality assurance system was in place but this was not effective. Tools were in place, such as questionnaires, to gather the views of people and their relatives about the service they received, but their views were not fully analysed by the provider to address any shortfalls. There was documentary evidence to show that when the provider was made aware of shortfalls, they did not address these, or if they did, this was not in a timely manner.
We have set a compliance action and 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 service provision.