We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well lead?
This is a summary of what we found:-
Is the service safe?
We spoke with two care staff who demonstrated a lack of understanding of how to safeguard people from potential abuse. We found that a number of staff had not received safeguarding training. Although people told us they felt safe, there was a risk of them not being protected from abuse because staff did not know how to.
Discussions with the registered manager and our observations confirmed that there were sufficient staffing levels provided during the day time to meet people's needs. However, the registered manager was not entirely confident that during the night time there were sufficient staffing levels to carry out an evacuation in the event of a fire. We have shared these concerns with Shropshire fire and rescue service who will carry out an inspection.
A number of people who used the service lacked capacity to consent to some aspects of their care and treatment. The registered manager informed us that where necessary a best interest meeting would be carried out to ensure any decisions made would be in the person's best interest. However, records were not maintained of these meetings.
The registered manager said that they had not made any applications for Deprivation of Liberty Safeguards (DoLS) but this would be reviewed when necessary. DoLS is where a person receiving care who also lacks capacity may have their liberties restricted, to ensure they receive the appropriate care and treatment.
The staff training programme showed gaps where staff had not received training and this was acknowledged by the registered manager. For example, a number of people who used the service lacked capacity to give consent to care and treatment due to their health condition. The training programme showed that a number of staff had not received Mental Capacity Act (MCA) training. The staff we spoke with had a lack of understanding of MCA. This meant that people who lacked capacity could not be confident that all staff would have the skills and competence to care for them appropriately.
Is the service effective?
The registered manager said that a pre admission assessment was carried out before a person was admitted to the home and this was confirmed by a visiting relative. This meant that people could be confident that their assessed care needs would be met when they moved into the home. One person who used the service told us, 'I came to visit the home before I moved in." "I liked it and told them I wanted to live here.' This process enabled the individual to make an informed decision to whether the service would be suitable to meet their needs.
Discussions with the registered manager confirmed that people had access to an advocacy service and this was confirmed by one person we spoke with. An advocate helps a person to say what they want, securing their rights and represents their interests.
Some people had limited verbal communication and we observed staff communicating with people in a manner they could understand. For example, using Makaton and pictures. Makaton are signs and symbols used to help people to communicate.
Is the service caring?
The people who used the service told us that they were involved in reviewing their care plan and were happy to show us their care plan. One person said, 'Most of the staff are alright, they do look after me.'
We observed that people had access to various social activities and were supported by staff to access leisure services within their local community. One person told us, 'It's not bad living here, I enjoy going out, I went shopping this morning.' We looked at four care plans that provided relevant information to promote staff's understanding about how to care for the individual.
We spoke with one visiting relative who told us, 'I see X regularly and the staff are so welcoming.' Discussions with one person who used the service confirmed that staff supported them to maintain contact with their friend. Care plans showed relatives and friends that were important to the individual and how to support them to maintain contact.
We saw that each bedroom was decorated to reflect the person's choice and interests. One person told us that they were pleased with their room and said, 'I chose the colour and the furniture.'
We observed that people were dressed in a way that reflected their style and personality and one person said, 'I can wear what I like.' Discussions with staff confirmed that where necessary people were supported with their personal care needs. We observed that one person's top was soiled and a staff member discretely took them to their room to change it. This ensured that the person's dignity was maintained.
Records and discussions with people who used the service confirmed that they had access to other healthcare services when needed. This meant that people could be confident that their healthcare needs would be met.
Is the service responsive?
We found that where a person's healthcare needs had changed, the care plan had been reviewed to ensure the person received the appropriate support. We spoke with the person this care plan related to who confirmed that they were happy with the care they received. We looked at four care plans that provided staff with relevant information about how to care for the individual.
The provider had an auditing system to ensure people received the appropriate care and treatment. However, we found that where shortfalls had been identified there was no evidence of what action had been taken to address this. For example, the audit records showed that staff were not always consistent in signing the medication administration record (MAR), to show people had received their prescribed treatment. The manager acknowledged this and said that measures would be taken to identify what action had been taken.
Is the service well led?
The management team consisted of two registered managers who both demonstrated a sound understanding of the care needs of people who used the service.
Discussions with the registered manager and the records we looked at showed that people had access to information in a format they could understand. For example, we saw that the home's complaint procedure and some parts of the care plan were available in a pictorial format.
The registered manager told us that meetings were carried out with people who used the service and this was confirmed by one person who lived there. They told us, 'We talk about holidays and the menus.' This meant that people were actively encouraged to be involved in the running of the home.