The inspection team who carried out this inspection consisted of one inspector and an expert by experience. During the inspection, we spoke with seven people, two relatives, the regional manager, the home manager, deputy manager and eight staff. We looked at five sets of care records and six staff files. The home had three different units for residential care, dementia care and nursing care. We visited each of them and observed care practices .The service had a registered manager in post. The manager of the home had been in post since January 2014 and was working to increase staff morale and to create a more positive environment for staff and for people living at the home. Some staff spoke positively of the support which they received from their manager.
Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.
During the inspection, the team worked together to answer five key questions which are outlined below.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
People told us they felt safe and secure living in the home. People living at the home were knowledgeable about the action they needed to take during an emergency evacuation. Not all staff spoken with were knowledgeable of the procedures they needed to follow.
The staff we spoke to understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.
We inspected the staff rotas and dependency tool which showed that there were sufficient staff on duty to meet people's needs throughout the day. However we saw that staff were very busy throughout the day. Staff, relatives and people living at the home expressed concerns about staffing levels on the nursing unit.
We found gaps in the recording of information in people's records, activity schedules, staff rotas, audits and training records. We found some records were unavailable during inspection. Records did not contain all the information required by the Health and Social Care Act. This meant the provider could not demonstrate that people were protected from the risks of unsafe or inappropriate care because records were incomplete. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
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. Only half of the staff team had been trained to understand where an application should be made, and how to submit one.
Is the service effective?
People had personalised care plans which was set out in their care needs. We could not see if people had been fully involved in the assessment of their health and care needs and if they had contributed to developing their care plans.
There were gaps in the information provided in some people's care records and the frequency of which assessments were carried out. During our inspection we saw very little therapeutic activities taking place.
Staff responded quickly when people's needs changed. People had regular access to a range of health care professionals, some of which visited the home. People told us staff escorted them to healthcare appointments if needed.
It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people when they regularly worked on the same unit. However this was not always the case when staff were moved onto a the nursing unit.
Is the service caring?
People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.
Staff were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records looked at told us that individual wishes for care and support were taken into account and respected.
Is the service responsive?
Records showed that the home responded quickly when people became unwell. There was good evidence of multi-agency working.
People we spoke with knew how to make a complaint.
Is the service well-led?
Staff were clear about their roles and responsibilities. They understood the values of the home.
Staff training, appraisals and supervision were not up to date. This meant the provider could not demonstrate that people were protected from the risks of unsafe or inappropriate care. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
The home had a system to assure the quality of service they provided. Some audits were carried out and the regional manager regularly visited the home. People who lived at the home had completed a customer satisfaction survey.
What people said
Some people who were able to express their views told us they were satisfied with the care and support they received. One person stated, 'The care is smashing.' One relative we spoke with told us, 'It's lovely in here and the staff are really nice.'
However not everyone we spoke with felt they were well looked after. One person we spoke to thought that the staff didn't undertsand their care needs. We spoke to the manager about this. Another person told us, "There isn't enough staff to do what I want do. The staff leave me sat in a chair.'
Most of the staff we spoke with during the inspection told us they had concerns about the number of staff on the nursing unit. One member of staff told us, 'An extra member of staff is needed. There is an accident waiting to happen.' Another member of staff told us, 'How can we deliver good care if there are not enough staff.' People we spoke with also expressed concerns and told us, 'If there was more staff I might even be able to go out' and 'It would be lovely if staff had time to sit and chat.'