Archived: Support in Mind (Dementia) Team

The inspection took place between 6 and 24 October and on the first day of the inspection we arrived unannounced as we were unable to get in contact with the provider. At the time of the inspection there were 15 people using the service.

A registered manager was not in place. 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. A new manager had been appointed, had applied to be registered with the Care Quality Commission and was going through the registration process.

We were unable to speak directly with people who used the service as they were not able to communicate their experience of the service with us. However, we did speak with relatives and carers of people who used the service to get their views, as well as contacting health professionals and staff.

Relatives provided positive feedback about the service and said it provided high quality care which met people’s individual needs and requirements. Relatives said care was delivered by kind, compassionate and competent care workers.

Medicines were not managed in a safe way. A lack of accurate records made it difficult for us to establish whether people had received their medicines as prescribed.

Relatives and health professionals praised the safety of the service. Safeguarding procedures were in place and we saw evidence these were followed to keep people safe. Risks to people’s health and safety were assessed. Staff we spoke with demonstrated a good understanding of what they needed to do to minimise any risks to individuals, however, some risk assessment documents required additional information adding to them.

There were sufficient staff deployed to ensure people received a consistent and reliable service. Safe recruitment procedures were in place to ensure staff were of suitable character to work with vulnerable people.

Overall, we concluded the service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DolS) although documentation did not always provide a clear audit trail that the service was acting appropriately.

Staff received a range of training and support and demonstrated a good knowledge of the subjects and people we asked them about. There was a low turnover of staff and people received care from the same group of care staff which helped the development of specialist knowledge about individuals.

Although some aspects of the service supported the claim that the service provided specialist dementia care, there was a lack of strategy to ensure proper dementia care planning and to enable the service to keep up-to-date with the latest developments in dementia care.

Relatives told us people‘s healthcare needs were met any changes in health were quickly communicated to them. Staff demonstrated a good knowledge of how to act if people’s condition changed.

Relatives told us staff were kind and considerate and treated them with dignity and respect. Staff had a good knowledge of the people they were caring for, including their individual likes, dislikes and personal preferences. The service had enabled people to stay living in their own homes for longer and maintain their independence.

People’s needs were assessed and plans of care put in place. However, some plans of care contained inaccurate information or were not thorough and person centred enough.

People received consistent care and support and the times that they needed it. Staff stayed for the correct amount of time and relatives told us the required care and support tasks were carried out.

A system was in place to log, investigate and respond to any complaints. Relatives we spoke with told us they were very satisfied with the service.

The provider had not submitted all required notifications to us such as allegations of abuse and notification of a serious injury.

We found a positive culture within the service, with staff demonstrating a dedication to providing a high quality and caring service. Relatives praised the overall quality of the service provision and gave numerous examples of how the service had delivered positive outcomes for people and exceeded their expectations.

Systems to assess, monitor and improve the service were not sufficiently robust and there was a lack of proper systems to formally gather and act on people’s feedback about the service.

We found two breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at the back of the full version of this report.

During our inspection visit we spoke with the acting team leader, the newly appointed team leader (who had been in post for a week), two support workers and one relative of a person using the service. The manager told us there were currently two people using the service and they had received five new referrals the week prior to our inspection visit. The acting team leader and newly appointed team leader were making plans to assess these new people while we were at the office.

The manager told us that from November 2012 the service had employed eight staff covering a relatively small area. They said the service had recently obtained approval for funding to expand its dementia service; they were recruiting new staff to the team to facilitate this. They also explained that they had recently been told the service would be expanding further to offer services to people with complex needs. They said there would be a newly created 'Complex Care Team' which would be managed by the same registered manager and team leader.

During our visit we found people's needs were assessed and care and support was developed from an assessment of their needs. There were enough experienced staff to meet people's needs and staff understood the importance of reporting suspected abuse.

The two support workers we spoke with told us they felt the care provided to people by the service was good and they felt well-supported. One of them told us, 'I think we do a good job, we don't rush anything. You have to be patient when you're dealing with people with dementia.'

The relative we spoke with told us, 'I can't thank them enough; they're marvellous really. I know my mum is being looked after properly. I don't know what we'd do without them.'