This inspection was unannounced and took place on 8 & 9 September 2016, the first day was unannounced. The service was last inspected in November 2013 and was found to be meeting all the regulations we reviewed.Teamcare Ltd are registered to provide accommodation for persons who require nursing or personal care at Highcliffe Residential Home. The provider is not permitted to provide nursing care. The home is located in a residential area of Whittle le Woods near Chorley and provides care for up to 24 older people. The home was fully occupied at the time of our inspection.
At this inspection we identified three breaches to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Within the main body of this report you can read the details of the identified breaches and see what action we have taken at the end of the report. We also made three recommendations within the report. Recommendations are made where regulations are not breached but steps should be taken to ensure quality and standards are maintained.
The service had a registered manager 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
All of the people we spoke with who lived at the home told us that they felt safe. We did find a number of accident and incident records showing that people had fallen, many of which were unwitnessed falls. A number of these issues needed to be reported to, or at least discussed with the local authority safeguarding team.
The home had a medicines management policy in place and all the people we spoke with felt their medicines were managed safely. However we found a number of recording issues within the Medication Administration Records (MARS) we reviewed. It was evident from looking at MARS and from discussions with staff that there were different systems in use for how some medicines were recorded.
We found some issues with prescribed creams. This included opening dates not being recorded which made it difficult to ascertain whether some creams were out of date or when the use by date was due to expire.
We saw that risk assessments were in place within people’s care plans which were regularly reviewed. However some risk assessments needed to be more personalised to the individual. Some of the resulting actions implemented via risk assessments were done without the recorded consent of the individual.
The service had robust recruitment policies which meant that the staff in the service had been appropriately assessed, interviewed and received the necessary clearances required to work with vulnerable people.
The home had the appropriate level of staff in place to meet the assessed needs of the people living at the home. No agency staff were used to cover for staff absences as this was done via the existing staff team and a small team of bank staff.
Staff received regular supervision from their line manager and told us that they felt supported in their work. However we found a number of staff had not received up to date training in some areas. The registered manager told us that training was being sought and we saw some evidence that this had either begun to happen or had been arranged.
Staff were able to talk about consent and how they gained consent from people prior to delivering personal care. However staff understanding of the Mental Capacity Act and how this legislation could potentially affect people living in the home was limited. We also found some issues with regards to written consent. We have made a recommendation about this.
People we spoke with were complimentary about the food they ate in the home. We observed people who needed assistance were helped in a patient and considerate manner by care staff. We did however find some anomalies between recorded information and what the cook and care staff told us about some people’s needs.
People and their relatives consistently told us that the approach of the staff team was kind, considerate and empathetic. We received a number of positive comments in this area. This was also backed up by the comments of professionals who were involved with the service.
Care staff we spoke with were knowledgeable about the provision of end of life care. Some staff had received specialist training in this area and established links were in place with a local hospice.
Care plans were in place and were in the main person centred. However the information within them was not always consistent and the information was not easy to navigate easily.
People and their relatives told us they knew how to make complaints and were confident that if they did they would be listened to.
The home had a dedicated activities coordinator and we saw good evidence that activities took place both within and externally to the home. Feedback was positive in this area.
People, relatives and staff spoke positively about the registered manager and how the home was run. We saw that all the staff team had a positive approach and the culture within the home was positive. There were clear lines of responsibility and accountability in place.
There was a good range of communication methods in place for people and their relatives including monthly newsletters and quality assurance questionnaires.
There was evidence in place that audits took place at the home however we questioned the effectiveness of some of these as they had not picked up some of the issues we found during the inspection. We have made a recommendation about this.