This inspection took place on 13 and 14 June 2016. This was an unannounced inspection.This location is registered to provide residential and nursing care for up to 16 people. People who used the service were older adults with personal care and nursing needs. At the time of the inspection, fourteen people lived at the service.
The service had a registered manager. 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.
Staff had completed training in safeguarding people from possible abuse. However, not all staff could explain what processes they needed to follow to keep people safe. We have made a recommendation about this.
The provider had not put in place full records to demonstrate safe recruitment practices. We have made a recommendation about this.
The provider had not routinely recorded that they reviewed people’s care plans and risk assessments regularly with people's involvement. The provider had not consistently recorded people’s views and wishes as to how their care should be provided. We have made a recommendation about this.
The provider had completed induction and supervision to address staff training and development needs to ensure people received effective care. Records of staff supervision were not made available to demonstrate that staff development needs were met to ensure people received effective care. We have made a recommendation about this.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications to restrict people’s freedom had been submitted to the appropriate DoLS office. People’s mental capacity was not appropriately assessed about particular decisions. When necessary, appropriate meetings were not held to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005. There was no recorded evidence people’s relative’s involved in best interest decisions had lasting power of attorney in place. This is required to enable them to lawfully make health and welfare decisions on the person’s behalf. Staff training in mental capacity and DoLS was not effective. Staff were not able to identify how people were subject to DoLS and how to apply the principles of the MCA in practice.
The provider had not considered accessible ways to inform people about services available to them, to include advocacy. We have made a recommendation about this.
People’s care plans were not personalised in all cases to enable staff to meet people’s individual needs, goals and preferences. Some people were not fully satisfied with the activities available to them. We have made a recommendation about this.
The provider had consulted people to obtain their feedback to influence how the service was developed. However, there were no records of how the provider responded to people’s requests and suggestions.
The provider's quality assurance system did not identify service shortfalls we found during the inspection, to ensure service improvements were made.
Medicines were administered and recorded safely and correctly.
Fire safety measures were in place to ensure people would be safely evacuated in the event of a fire. The provider completed health and safety assessments to ensure the environment was safe for people.
There was sufficient staffing level to meet people’s assessed needs.
People consistently had access to appropriate health professionals to effectively meet their health needs. People’s care and treatment was routinely reviewed with the involvement of relevant health care professionals to ensure their health, safety and welfare.
The service supported people to have meals that were in sufficient quantity, well balanced and met people’s needs.
People told us staff treated them with kindness, compassion and respect. People’s privacy and dignity was respected by staff. Staff promoted people’s independence and encouraged them to be as independent as possible.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.