Our inspection of 27 November 2013 found that, whilst there was a choice and sufficient quantities of suitable and nutritious food and hydration, people were at risk of not always being supported to be able to eat and drink sufficient amounts to meet their needs. There were not enough qualified, skilled and experienced staff to meet people's needs. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. The provider wrote to us in January 2014 and told us the measures that were being taken to address the issues. At this inspection we looked at these areas to check the progress the provider had made. At the time of this inspection there were 63 people using the service. We spoke with 10 people who use the service, five relatives, the manager, clinical deputy manager and 11 staff.
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?
The service is safe because there were enough qualified, skilled and experienced staff to meet people's needs. Staff we spoke with were aware of those people who needed support and encouragement to eat and drink sufficient amounts. This helped to ensure that people were protected from the risks of inadequate nutrition and dehydration.
The provider had taken steps to help ensure that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. These improvements will need to be embedded in practice and sustained.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager was aware of recent changes to the legislation and was awaiting further guidance from the provider organisation.
Is the service effective?
Most people had clear care plans that reflected the support they received. However, there was not an effective system in place to ensure that care and treatment was always planned and delivered in line with people's individual needs. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the planning and delivery of care in such a way as to meet people's individual needs and ensure their safety and welfare.
Is the service caring?
The majority of people we spoke with commented positively about the care they received. One person told us "'I am well looked after' and another person said 'The staff are kind'. Both told us they felt safe living in the home. Another person said 'I am well looked after. They can't do enough for me', and 'I am happy and safe and they are so good to me'. Another person commented 'I am very happy indeed, it is like a four star hotel. Everyone is very helpful and nothing is too much trouble'. A relative told us 'This home is excellent' and 'We tell everyone how good it is'.
We observed staff supporting people in a calm, caring and respectful manner. For example, we saw staff knocking on doors and asking if they could help with drinks or just looking in and checking how people were. One person had been calling out and we saw a care worker go and sit with them.
Is the service responsive?
The service acted responsively to peoples' changing needs. Staffing levels had been increased since the last inspection and were kept under review. The new care staff were deployed to focus on mealtimes and ensure people using the service had enough to eat and drink. One care worker told us 'Having nutritional help frees us up to care'.
We saw records of consultations with general practitioners and other health care professionals, in order to review people's health needs.
Is the service well led?
We found the service was well led and action had been taken to address the issues that were raised in the previous inspection report. We also saw that regular audits of the quality and safety of the service took place and were recorded.
People who use the service, their representatives and staff were asked for their views about their care and support and these were acted on. Meetings of the senior management staff within the service supported the effective organisation and running of the home. One care worker told us the home 'Is more organised now'. Another member of staff told us 'Things are better'; and 'We have a manager who has stayed now'.