A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
In this report the name Mrs Jo-Anne Jones appears, who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still identified as the registered manager on our register at the time.
This is a summary of what we found:
Is the service safe?
Prior to carrying out this inspection we had received concerns from a person who wish to remain anonymous. They alleged there were insufficient staffing levels to meet people's needs. We arrived at the home at 8.40am; there were five people in residence and two care staff on duty. The staff confirmed that two people required two staff to assist them with moving and handling. All the people that used the service required assistance with their personal care needs. This meant that when two care staff assisted one person with their care needs, four people were left unattended and at risk. The acting manager acknowledged that staffing levels were inadequate and confirmed that they were in the process of recruiting additional staff.
The people who used the service were reliant on staff to manage their prescribed medicines. We spoke with two care staff who confirmed that they had received medication training. We found medicines were stored in each person's bedroom in a secure cupboard. However, the key for the medicine cupboard was not securely maintained and was accessible to all people who used the service and others. This meant that medicines were not securely stored and could place people who use the service and others at risk.
We found that staff had a good understanding about safeguarding and various forms of abuse. However, the staff we spoke with recognised that practices in the home amounted to abuse but had not shared these concerns with the relevant agencies. For example, staff told us that people were not provided with enough food and that they had taken money from people's personal allowances to buy food. The financial records we looked at showed that funds had been used to purchase food on several occasions.
Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that proper policies and procedures were in place. DoLS were in place for all the people who used the service and relevant systems were in place to review this. Mental health assessments were also in place and routinely reviewed. Relevant staff had been trained to understand when an application should be made and how to submit one.
Is the service effective?
Prior to this inspection we had received a complaint that alleged there were insufficient funds to ensure people received a nutritional diet. On the day of the inspection we saw that food provisions were in place. However, discussions with two care staff confirmed that food provisions were inadequate to meet people's specific dietary needs. One care staff said, 'We often run out of food before the end of the week.' The acting manager told us that four out of five people had swallowing difficulties and had been referred to a speech and language therapist (SALT). The records we looked at confirmed people had access to SALT. We saw a chart in the kitchen that showed what foods were unsuitable for people who had swallowing difficulties. Discussions with a care staff and records we looked at confirmed that people who had swallowing difficulties were given meals that could lead to choking and the acting manager acknowledged this. This meant that people's specific dietary needs were not being met and placed them at risk of harm.
The staff we spoke with confirmed that a four week menu was in place but these were not used. One care staff said, 'We do not stick to the menus because we do not have the food in stock, we just cook what we've got.' A record of people's body weight was maintained. We found that people had lost weight over the last three months. We have shared these concerns with Shropshire County Council.
Is the service caring?
Due to people's health condition they were unable to tell us about their experience of using the service. We spoke with two care staff who demonstrated a good understanding of people's needs. Discussions with staff confirmed that they were aware of each person's specific needs but due to the lack of provisions and staffing these were not always met. For example, staff told us that social activities were limited due to staffing levels. On the day of our inspection we saw that people were not provided with any stimulation. Prior to this inspection we had also received concerns about the lack of stimulation provided to people. This meant that people were not provided with the relevant support to engage in social activities to reflect their interests.
Staff informed us that people were unable to communicate their needs. However, we observed one person pointed to express their needs. We saw that people's facial expression indicated their likes and dislikes and staff did respond to this. The acting manager said that care plans had recently been reviewed to include this information. However, we found that not all staff were aware that new care plans had been introduced. This meant that people could not be assured that all staff would have up to date information about how to communicate with them.
Is the service responsive?
The acting manager confirmed that they had received complaints about the service provided to people. However, this information had not been recorded and there was no evidence of what action had been taken to address the complaint. The acting manager said that the complaints would be addressed by the service manager.
Is the service well-led?
The acting manager had been in post for six weeks and was aware of the shortfalls we had identified during the inspection. They informed us that concerns had been shared with the service manager. However, we found that immediate action had not been taken to improve the service and protect people from further risk.
We found that quality assurance monitoring systems were inadequate to ensure people received a safe and effective service and the acting manager acknowledged this. For example, we found some discrepancy with the management of people's prescribed medicines. However, the auditing tool showed that medication practices were satisfactory.
Discussions with the acting manager confirmed that no efforts had been made to obtain the views of people who used the service or their relatives. This meant people did not have a say in the care and treatment they had received or how the home was run.