Signature House was last inspected on 9 December 2013 and found to be meeting all requirements in the areas inspected.
When we visited there no registered manager in post as the last manager had left on 18 February 2014. 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. However the provider had appointed a manager and an application to register this person had been made.
Signature House is located in Dorchester, Dorset. The home can accommodate a maximum of 48 people. Accommodation is provided over three floors and all bedrooms have ensuite facilities. At the time of the inspection there were 43 people living at the home. The home was divided into three separate areas, the first floor supporting people with moderate dementia care , the second floor for the care of people with nursing needs and the third floor supporting people with more complex mental health needs.
The provider had designated the responsibility for the cleaning of the home to an outside contractor. The home was not clean in all areas inspected. The kitchenettes located on each floor were not effectively cleaned. The food stored in these areas, such as sandwiches and pate were uncovered and undated. This put people at risk of unnecessary harm.
The provider had a system in place to ensure the suitability of new staff to work at the home. This system was not consistently applied to all new staff. We found that one recent employee had not had references taken up from their most recent care employee. This meant that all of the most current information available to the provider had not been used to check the suitability of this person to work at the home.
When people with enduring mental health issues, such as dementia, displayed challenging behaviour the staff did not consistently have documented guidance to enable them to support them safely. On the third floor we observed that staff did demonstrate that they had sufficient guidance and understanding to effectively support people with dementia. The provider had recently employed a member of staff to take the lead on developing staffs understanding of dementia and how to provide activities based on their individual needs. Whilst the staff knew people’s needs well, the records relating to people’s care and support were not always up to date and so they may not be able to provide care and support in the way people wished.
Most staff demonstrated a caring and compassionate approach to people living at the home but some improvements were necessary as we observed some staff did not always respond appropriately to people living at the home. People were offered choices at mealtimes such as where to sit and what to eat. A relative told us that the food on offer was generally very good saying, “I visit most days and there always seem to be enough choice and enough for people to eat, my husband has put on weight since coming here.”
There were sufficient suitably trained staff to meet people’s needs. The people we spoke with told us that, “the girls (staff) are lovely; they always help me and get me drinks when I want them”. Another person told us about recent improvements saying “there seems to be more staff around lately”. Relatives told us that they considered there were always staff around to help when required.
People told us they felt safe living at the home, they were aware of how to make a complaint. People told us that if there was an issue they would tell staff who would address this.
The provider had systems in place to ensure the quality of the service was regularly reviewed and improvements, some of these systems were still under development. The provider demonstrated that they had taken action and made improvements in the service offered and had a plan of continued improvements.
The provider was meeting the requirements of the Mental Capacity Act 2005 and assessments of people’s capacity had consistently been made. The staff at the home understood some of the concepts of the Act, such as encouraging people to make decisions for themselves. We observed that staff demonstrated that they could apply this to everyday life.
Staff told us they worked well as a team and enjoyed working at the home. They told us about the values and vision of the provider, one staff member told us, “I want to do something I am proud of; I know I will be able to achieve this here.”
We recommended that the provider looks at the activities provided to people with complex needs living at the home
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.