16 July 2014
During an inspection looking at part of the service
The inspection team was made up of three inspectors, one of whom was a pharmacy inspector.
We set out 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.
If you wish to see the evidence supporting our summary please read the full report.
Safe
At the last inspection we found the service did not have enough suitably qualified, skilled and experienced staff to meet people's needs. During this inspection we found improvements had been made. The nursing staff hours had been increased by six hours a day and at the time of the inspection the provider was recruiting additional care staff. Most of the feedback from people who used the service was positive; however, some people said their experience was that some staff were more attentive than others. Some people also expressed the view that it was not always easy to find staff when they needed them.
We found people were not protected from the risks associated with medicines because the provider did not have effective processes in place to make sure medicines were managed safely.
The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, they were able to describe the circumstances when an application should be made.
Effective
Overall the people we spoke with were satisfied the service met their needs.
One person said their relative had not been at the home very long but had settled in well. They said they were satisfied their relative was well cared for and said staff kept them informed. They said if they had any questions or concerns they were dealt with immediately.
We saw people had access to a range of health care professionals who visited them at the home.
We found people's care records were up to date and contained information about their individual needs and preferences. We saw people and/or their relatives were involved in reviewing their care plans.
Caring
Several described the staff as 'caring', 'very good', 'skilful' and 'responsive'. One person said 'The staff are lovely, very gentle and kind'.
We observed staff were kind and considerate in their interactions with people. We saw staff sitting chatting with people and observed they were attentive to people's needs. For example, we saw one person rubbing their stomach and staff responded quickly asking the person if they were unwell.
Responsive
Two people who used the service said staff listened to them and took notice of what they said. The home had a day centre and also employed separate staff to provide social activities and stimulation for people who used the service. When the Healthwatch team visited the home, on 7 July 2014, they observed there was a lack of meaningful activities for people living with dementia. They also observed the environment on the dementia care unit was not designed to support and/or promote people's sense of wellbeing.
The relative of one person who used the service said the day centre was very good but was concerned staff were not always available to help their relative to get to and from the day centre. They said they had raised this on numerous occasions but it didn't change.
One person who used the service told us they had been out on two trips recently which they had really enjoyed. However, a visitor told us their relative had only been supported by the home to go out on two occasions in two and a half years since they moved in.
Well- led
At the last inspection in April 2014 we found that improvements had been made but we still had concerns about the effectiveness of the systems the provider had in place to monitor and assess the quality of the service and to identify, assess and manage risk.
During this inspection we found the provider was continuing to make improvements to this aspect of the service. For example, at the meeting for people who used the service in June 2014 some people had mentioned that the food was cold when it was served. We saw action had been taken to address this, for example by providing new hot food trolleys. We also saw the service was giving people information about the actions they had taken in response to their feedback. This took the form of a colourful notice with the headings 'What you told us' and 'We did'. The 'We did' section told people about a new seating area in the garden and changes to the menu. In the course of the inspection we were able to confirm these changes had been implemented.
We found improvements had been made to the way accidents and incidents were dealt with and there was evidence of learning and actions to reduce the risk of similar accidents/incidents happening again.
However, we felt further improvements were needed to demonstrate the processes were working effectively. We were particularly concerned that the provider's processes had not identified the on-going risks in relation to the safe management of medicines.