We undertook an unannounced inspection on 9 September 2015. The inspection continued on the 11 September and this was announced
The service is registered to provide accommodation and personal care for up to 10 adults. The service has eight single rooms and one double room that is used for single occupancy. When we carried out our inspection there were eight people living at the service. There are two bathrooms, one of which has a walk- in bath. The service has a lounge and dining area that people are free to use at any time. The accommodation is over two floors and the first floor can be accessed by a stair lift. The majority of the building would not be suitable for the use of a hoist to support people with moving and handling. Each room has a call bell fitted so that people can call for help when needed.
The service has 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.
People told us that they feel safe living at the service and had confidence in the people who cared for them. They told us that there were always staff about to help them and they responded quickly to call bells. Staff told us that they had regular safeguarding training and knew how to recognise and report any signs of abuse. We looked at staff recruitment and found that staff were being recruited safely with all the necessary checks carried out. Staff files contained evidence of training, supervision and a yearly appraisal. Staff had received the mandatory training and in addition training specific to the needs of the people living in the service. An example was a person had moved to the service and had diabetes and staff recognised that they needed additional training to understand the condition and support the person.
Each person had care files that contained assessments of any risk to their health and wellbeing. Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they choose to live their lives. When we spoke to people using the service we found that the records didn’t consistently reflect what we were being told or what we observed. We raised this with the registered manager who agreed to review the risk assessments and care files.
Medication was stored safely and records were being kept accurately. However, we were told that one person was self-medicating her insulin and risk assessments were not in place to ensure her safety.
Records for the maintenance and service of equipment was up to date, this included fire drills being held with all staff six monthly. Personal fire evacuation plans were not available to evidence on day of inspection. These are to ensure each person’s individual risks are understood in the event of an emergency. We also found that the emergency contingency plan was not available to evidence. This would contain information on how the service would keep people safe in the event of a major incident which affected the running of the service.
We found the home clean in all areas other than one bedroom and the reasons for this and the actions taken were well recorded. The records demonstrated a good understanding of the person’s history and the least restrictive measures taken to reduce any risk of infection.
People told us that they are always cared for by people they know and who knew them well. We spoke to a mental health professional who had supported a person moving into the service. They told us “The staff have taken time to understand him and his needs. They showed compassion and understanding”.
Each person living at the service had a mental capacity assessment carried out prior to admission. We found that a mental health review had been carried out for one person by the community mental health team. The mental capacity review the service were carrying out each month did not reflect this information. Although senior staff have completed training more understanding is needed of the legislation. This is so that people who lack some mental capacity are safeguarded and decisions about their care and treatment are made in line with the legislation protecting their best interests. We discussed with the registered manager who told us he will arrange more refresher training for senior staff.
People told us that the food was good, one person said “Some food is very good, they make lovely sauces”, another person told us “You’re offered two choices for lunch”. People’s weight was monitored and the staff were aware of the support available from specialist dieticians should it be needed. People told us that they regularly have access to GP’s, chiropodists, opticians, dentists and other health professionals.
People, their visitors and health and social care professionals all told us the service was caring. One health professional said “Would be happy for my mum to live in the home, the staff really know the residents”. A GP told us “They look after people with care and love”. One person told us “I have a little chat with the staff when they help me; it keeps me in touch with the real world”.
Six people of the eight people living in the service spent most of their time in their rooms. Four of these people told us they enjoyed being in their room all the time. A visitor told us “I visit weekly; the person I visit doesn’t want to go out but likes to be in their room. They enjoy music and do crosswords and have a daily newspaper”. However another person told us “Don’t feel free enough. Could do with a change of scenery”. Although most people we spoke to were happy with how their time was spent not everybody felt they had been given the opportunity and support to make choices about doing things that interested them.
Earlier in the year we had received a concern about a lack of information when a person was transferred to hospital. We looked at the paperwork the service uses which includes information about why the emergency admission was needed. It also included a list of medication and a record of all the medication taken that day and important contact numbers. The information provided would ensure people get consistent health and medical care. At times people will be transferred to another service and not have the mental capacity to explain how they like to be supported with their care. Information added to the transfer information about the individual care and support needs of people would ensure consistency with person centred care.
People, their families and friends, health and social care professionals and the staff all told us they felt the service was well managed. The manager carries out regular quality audits, including health and safety, moving and handling, accidents and incidents and medication. The audits were up to date and any actions identified had been completed. The service has a complaints process and also annually asks people who use the service and their families to complete a quality assurance questionnaire to gather information about how people view the service. We saw that information gathered was acted upon to improve the experience for one person using the service.