7 and 12 October 2015
During a routine inspection
We inspected this service on 7 and 12 October 2015. The inspection was unannounced.
We were not able to gather all the evidence we needed to make a judgement on the first day of our inspection because the provider and the registered manager were not available to speak with us. We went back on a second day to make sure they had the opportunity to tell us how they managed the service and about their plans for continuous improvements.
There was a registered manager in post. 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.
The service provides accommodation, nursing and personal care for up to 23 older people who may be living with dementia, a physical disability or sensory impairment. On the day of our inspection, 17 people lived at the home.
The provider’s policies and procedures to minimise risks to people’s safety were shared with the staff. Staff understood their responsibilities to protect people from harm and were supported to raise any concerns. The registered manager assessed risks to people’s health and welfare and people’s care plans minimised the identified risks.
There were enough staff on duty to meet people’s needs. The registered manager checked staff’s suitability to provide care during the recruitment process.
The provider’s medicines policy included training staff and checking that people received their medicines as prescribed, to ensure people’s medicines were administered safely.
People received care from staff who had the skills and experience to meet their needs effectively. Staff understood people’s needs and abilities because they read the care plans and shadowed experienced staff until they knew people well. Staff were supported and encouraged to reflect on their practice and to develop their skills and knowledge.
The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had applied for a DoLS for one person to make sure they had legal authority to take the agreed actions to keep the person safe. For people with complex needs, their families and other health professionals were involved in making decisions in their best interests.
Risks to people’s nutrition were minimised because staff knew about people’s individual dietary needs. People were offered a choice of foods and were supported to eat and drink according to their needs.
Staff were attentive to people’s moods and behaviours and understood how to minimise their anxiety. People were supported to spend time with other people who lived at the home. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health and when their health needs changed.
People and their relatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs and abilities and care plans were regularly reviewed.
People and relatives told us care staff were kind and respected their privacy and dignity. They were confident any concerns would be listened to and action taken to resolve any issues.
People and relatives were encouraged to share their opinions to enable the provider to make improvements in the quality of the service. Staff were guided and supported in their practice by a management team they respected.
The provider’s quality monitoring system included regular reviews of people’s care plans and checks on equipment, medicines management and staff’s practice. The provider’s visions and values were understood and shared by the managers and staff. The focus of the service was to ensure people enjoyed the best possible outcomes from the service delivery.
Plans to improve the quality of the service included improvements to the environment to better support people with dementia and including people’s wishes for how they would like to be cared for and supported towards the end of their life.