This inspection was carried out by a CQC inspector. We spoke with five people who used the service, three relatives, two members of staff, the assistant manager and a health care professional. We also reviewed records relating to the management of the home which included three care records, daily care records, medication records, staff training records and minutes of staff and meetings for people who used the service. We used the information to answer five questions we always ask: Is the service safe?
A robust safeguarding procedure was in place. Two people using the service were able to tell us what they would do if they were not being treated properly. All staff had undertaken training in safeguarding and were clear about their responsibilities to report any incidents of potential abuse.
Some people were unable to make complex decisions about their care and treatment. In these circumstances the decisions had been made in their best interests that had included a multi-agency discussion and involvement of relatives. A relative told us, "We are so grateful for the care, they are excellent staff who always involve us in any decisions that need to be made".
A safe system of medication was in place that ensured that people were protected against the risks associated with with the unsafe use and management of medicines. Some clarity is needed in records relating to prescribed creams to record when, how and where they should be applied.
We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. The service had procedures in place to apply for this authorisation. We saw that two applications had been authorised due to each persons high dependency needs and vulnerability. The decisions had been made in their best interests.
We saw that risks to people's safety had bee identified and assessed to ensue that appropriate care and support was provided to keep people safe.
Is the service effective?
Two people told us that they were happy with the care they received and felt that their needs had been met. We observed that staff engaged in meaningful conversations with people and we saw examples of how they respected people's dignity. A member of staff explained to a person how they could make choices and said, "If someone comes to the door and you did not wish to see them, we would inform them of your wishes. It is your house and you make the decision."
A relative told us, "Three members of our family went to a multi agency meeting recently about X remaining here as their medical condition has deteriorated. We were pleased that staff and health professionals established a plan to care for X to remain and be cared for at home."
We saw from records and people told us they were consulted about the care they received. We noted that people's wishes and choices had been clearly written in care plans.
We saw the provider considered the needs of people with physical, sensory and communication needs and offered support to improve the quality of the service they received.
Is the service caring?
The relatives of three people using the service expressed high levels of satisfaction with the service. A relative told us, "We never have any cause for concern. X is having better care here than they have had anywhere."
People were supported by kind, sensitive and attentive staff in a way that respected their dignity. A relative we spoke with told us, "They take X out for meals and to bowling, although they can't join in X enjoys watching and the company." Another relative told us, "I like the fact that we can come anytime and X is always well-presented, washed, shaven and well dressed."
Is the service responsive?
We saw from reviews of people's care needs that plans of care had been adapted to meet their changing needs and wishes.
We saw that minutes of staff meetings and meetings of people who used the service had been actioned to improve the quality of the service. Staff told us that they felt comfortable in raising any concerns or to make suggestions for improvements. They felt listened to.
We observed that staff provided personalised care and support. They respected people's wishes and their agreed plan of care. People and their families were encouraged to be involved in making decisions about their care and treatment.
Is the service well-led?
People told us that the manager and staff were approachable and helpful.
A visiting professional we spoke with told us they felt people were well supported and were offered a good service. The visitor told us the service had been pro-active in making early referrals concerning health care matters. They said that joint working had been a positive experience with the home.
The service had a quality assurance system and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result the quality of the service was continually improving.