We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer to answer questions we always ask:' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found:
Is the service safe?
The manager had identified the risks and hazards associated with providing care within the home. These included risks associated with electrical equipment, kitchen, the use of step ladders, smoking and fire safety. We also saw risk assessments associated with specific elements of people's care, such as psychological risks, falls and financial mismanagement.
Systems were in place to ensure the manager and staff learn from events such as complaints, concerns, or safeguarding events. This reduced the risk to people and helped the service to continually improve. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications have been made. Relevant staff had received training to enable them to understand when an application should be made. This meant people would be safeguarded as required.
When the manager sets the staff rosters, they take people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure there were enough staff to meet people's needs.
Is the service effective?
The care plans we looked at were personalised to reflect the individual needs and people's likes and dislikes. The people we spoke with told us they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with the staff that they had a good understanding of the people's care and support needs and they knew them well. A person we spoke with told us staff 'seem to know what my requirements are. When I came here they already knew what I needed. They were ready to look after me'.
Care records showed people had access to appropriate medical care, including GPs, dentists and chiropodists. A care manager said, 'Staff have a very good understanding of his [the person they were supporting] needs'. Therefore people's needs were known and met.
Staff received appropriate training to meet the needs of people living at the home.
Is the service caring?
People were supported by staff who did not always treat them with respect and dignity. We observed care in the communal areas of the home and saw staff interacting with people in a supportive way. However, during our observations we over heard two members of staff engaged in inappropriate banter between themselves and then later with one of the people using the service. Staff did not always consider how their behaviour may impact on others.
People told us they 'liked the home' and staff 'looked after them'. One person said 'I like it here. I like the staff and the way they treat us'.
The home provided an opportunity for feedback through regular service user's meetings and annual surveys.
People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with their wishes.
Is the service responsive?
People using the service had a high level of independence and were all mobile and had the freedom to go out into the community on their own. Their care plans and the support provided by staff reflected their individual abilities.
There was an effective compliments and complaints policy in place, which was included in the service user's guide. All of the people spoken with said they knew how to complain but had not done so as there was no need. One of the people we spoke with told us, 'I would complain to staff if I have a problem'. The manager showed us their complaints file and told us they had not received any formal complaints during the last year.
Is the service well-led?
We saw there was a structured quality assurance process in place to regularly assess and monitor the quality of the service people received. These included cleaning and infection control audits; medication administration record (MAR) audits; call bell alarm tests and fire safety equipment audits. We found some of these audits were also carried out by external professionals. Where remedial action was identified we saw that this had been completed.
There was a staff meeting structure, where staff could raise any issues or concerns. The staff we spoke with told us the staff meetings were an opportunity to raise any concerns or issues they had. One member of staff said, 'We have regular meetings, the last one was about a month ago but you don't have to wait for a meeting you can raise an issue at any time with the [manager] or [provider]'.