On the day of our visit there were 58 people using the service. We spoke with eight people who used the service, two people's relatives and carried out a short observation framework (SOFI). A SOFI is used to capture the experiences of people who use the service who may not be able to express this for themselves.The home offered residential care, nursing care, intermediate care and dementia care. The home is part of The Order of St John Community Trust.
We considered our inspection findings 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?
People were cared for safely. Risk assessments were in place and regularly reviewed. People's needs were assessed and reflected in the care plans.
There were arrangements in place to deal with foreseeable emergencies. There was emergency lighting and plans for managing the person's needs in the event of a power failure. Each person had an emergency evacuation plan for use in the event of a fire.
At our previous inspection we raised concerns that medicines were not always kept safely and securely because one of the fridges containing medication was broken. We had also seen some medication was not stored in a safe and secure way. Since our inspection the provider had purchased a new fridge for each clinical room. Daily temperature checks of the clinical rooms and medication refrigerators were recorded. They showed that the refrigerators were working effectively. We saw that all medication was locked away. in cupboards and metal trolleys which were secured to the wall when not in use. We concluded that appropriate arrangements were in place and medicines were kept safely and securely.
Systems were in place to make sure that managers and care workers learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to continually improve.
The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager had previously made DoLS applications where it was in a person's best interest to do so. There were no people subject to a DoLS at the time of our inspection.
Is the service effective?
The service was effective. People had individual care plans which set out their care needs. People's needs were assessed and people told us they were involved in their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.
Care workers told us they felt supported in their role. One care worker told us "I love my job; we are a good supportive team'. Another told us 'the manager is very approachable and supportive'. Care workers received an annual appraisal and were able to complete appropriate training. This meant care workers were appropriately trained and supported to care for people living and staying at Isis House.
Is the service caring?
The home was caring. People we spoke with were complementary about the home. One person said, "staff are always very pleasant, helpful and prompt when I buzz for them'. A relative told us "It's very good, caring. Mum's safe and well looked after'. During the SOFI observation we observed a person who was in bed and may not have been able to summon care workers. Throughout the observation we noted that whenever care workers walked past this person's room they went in. At times care workers stayed for a few minutes chatting to the person without performing any care tasks. On other occasions the person was assisted to have a drink or change position. This meant that this person received appropriate care and benefitted from good interactions with care workers. Throughout our inspection the atmosphere was pleasant and we observed many interactions between care workers and people that were caring, relaxed and friendly.
We found that people's privacy and dignity was protected. Care workers we spoke with could describe the action they would take to ensure people's privacy and dignity was protected during care tasks. These included keeping curtains drawn, closing doors and ensuring people were covered during personal care. People we spoke with told us that they felt care workers respected their privacy. One person told us 'they always knock on my door and close the curtains'.
Is the service responsive?
The home was responsive. We saw evidence that care workers recognised when a person's condition changed or their health had deteriorated and sought the help and advice of other professionals. For example, we saw that one person had suddenly become unsteady on their feet and had a fall. Their urine was tested which identified they had an infection. The GP was contacted who prescribed antibiotics. It was noted that following the antibiotics this person's mobility had improved. This showed us that care workers were responsive to people's needs.
Is the service well-led?
The service was well led. The home worked with other agencies and services to make sure people received the care they needed.
Care workers told us they felt able to raise any concerns with the manager. One care worker told us ''the manager has an open door you can talk to them about anything'. This meant that care workers felt confident that they would be listened to and that any concerns they had would be taken seriously.
During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the service was monitored on a consistent basis to ensure that people experienced safe and appropriate support, care and treatment.