During our inspection we looked at how well people were cared for, the safe management of medicines, the safety and suitability of the premises, staff recruitment, and the quality monitoring systems in place. We also looked at record keeping and whether this was effective in keeping people safe. The summery is based on our observations during the inspection. We spoke briefly with two people living at the home, a relative who was visiting, two members of the care staff team, the registered manager, and deputy manager. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found.
Is the service safe?
From our observations people appeared relaxed, comfortable and secure. We saw that people were treated with respect and dignity by the staff team and their rights protected.
The home had information and procedures in relation to the Mental Health Act and Deprivation of Liberty Safeguards although no application had needed to be submitted. Staff were being trained to understand when an application should be made. This meant that people would be safeguarded as required.
The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.
We looked at the recruitment of new staff. This showed that some required recruitment checks in respect of references and qualifications and training were not always being obtained prior to the person taking up their post at the home. This potentially put people at risk of being supported by staff that did not have the personal qualities or appropriate skills.
Some medication records we saw were incomplete. Therefore it was not possible to be confident that medication had been administered as prescribed. Staff had failed to report omissions in record keeping. These practices did not protect people or keep them safe.
We have asked the provider to tell us what they are going to do to meet the requirements of law in relation to recruiting new staff, medication, the monitoring the service provision and record keeping.
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It the service effective?
There was an advocacy service available if people needed it. This meant that people living at the home or their relatives could access additional support. The relative we spoke with told us that they were very pleased with the level of care that was being delivered in the home and that staff were, '100% working in partnership with the family's wishes.'
From our observations and through speaking with staff it was clear that there was a good understanding of each person's assessed needs and that personal preferences were accommodated.
We were assured that in the main, people's health and care needs had been assessed prior to admission and that the individual or their family were aware of the care being delivered. However we could not look at most of the pre admission assessments we asked for, as they could not be located. We also noted that although some assessments had been completed, the outcome of the assessments had not necessarily been carried forward to an individual care plan such as social activities. This meant that people may not have been provided with their preferred activities because staff had not been made aware of them.
People or where appropriate their relative, had not necessarily seen or had been given the opportunity to agree to the content of their initial care plan. Although no concerns at all were expressed about the level or type of care being provided, there was never the less potential for care to be delivered in a way that did not meet the expectations of the individual.
The internal quality monitoring systems in place had latterly not always focused on important areas in relation record keeping, including the development of holistic care plans. This meant that important records were missing or incomplete.
People's mobility and other needs had been taken into account in relation to the adaptation of the building, meaning that people were able to move round freely and safely.
We asked the provider to tell us what they were going to do to meet the requirements of law in relation to ensuring that people had a detailed and holistic pre admission assessment and care plan that encompassed all aspects of their assessed needs and requirements.
Is the service caring?
We saw that people were supported by kind and attentive staff. Care workers showed patience, humour and gave encouragement when supporting people. A relative told us, 'I cannot fault them. Everything is handled professionally. The staff are lovely, very caring and patient with people'.
Relatives and where appropriate people living at the home, had been provided with an annual satisfaction survey. We viewed the outcome of the most recent survey. Outcomes were positive. Action had been taken to address any suggestions made.
We also saw the minutes of staff meetings, entertainment meeting minutes, kitchen meeting minutes and management meeting minutes. Outcomes of residents' rendezvous meetings were highlighted in the monthly newsletter. These different forums gave people opportunity to have their say and influence change.
Is the service responsive?
People enjoyed a range of activities inside and outside the home. The home had its own adapted mini bus that helped people to keep involved in their local community. The home encouraged activities and we saw numerous things happening during the inspection, both collectively and on a one to one basis with individuals.
The home had received no formal complaints for some considerable period of time. People we spoke with did not express any complaints or concerns. The complaint procedure was on display in a communal area of the home for people or their relatives to access at any time. We looked at how the one complaint had been dealt with, and found that the responses had been open, thorough and timely. People would therefore be reassured that complaints were investigated and action taken as necessary.
Is the service well-led?
The registered manager had been in post for many years. The registered manager, deputy manager and staff team worked closely together on a daily basis. This helped to ensure standards were maintained and any shortfall quickly addressed. In addition, a range of routine audits was also completed. However some audits that could prove useful, such as medication audits, were not in use. This meant that shortfalls had not been identified and addressed. The audit systems did not systematically ensure that all the necessary documentation was completed or that record keeping was robust and routinely applied.
We asked the provider to tell us what they were going to do to meet the requirements of law in relation to ensuring that the required documents were routinely completed and that record was robust.