This inspection took place on 28 April 2015 and was unannounced.
Diwali Nivas is a care home that provides residential care for up to 16 Asian elders who may in addition experience dementia or a mental health condition. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care. At the time of our inspection there were 15 people in residence.
A registered manager was 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 registered provider was also the registered manager at this service.
People were happy and told us that they felt safe. Staff were able to explain how they kept people safe from abuse, and knew what external assistance there was to follow up and report suspected abuse. Staff were knowledgeable about their responsibilities and trained to look after people and protect them from harm and abuse.
There was an on-going refurbishment in the home which restricted the space the dining room and lounges. We spoke with people and their relatives, who understood the current situation was for a limited time.
Staff did not always communicate people’s dietary needs properly, which allowed people to be at risk of choking. People’s care and support needs had been assessed and were involved in the development of their plan of care. People told us they were satisfied with the care provided.
Staff were recruited in accordance with the provider’s recruitment procedures that ensured staff were qualified and suitable to work at the home. We observed there to be sufficient staff available to meet people’s needs and worked in a co-ordinated manner.
Most medicines were stored safely, however some creams were stored in bedroom areas. These were not locked away, so open to anyone entering the room. We found a number of these were not dated on being opened, so we could not tell how long they had been in use, and assess if they remained active. There were also a number of these that had the label obscured, so again we could not ascertain if they were prescribed for a particular person, or how often they should be applied. People received their tablet, capsule and liquid medication as prescribed. Staff were trained in medicines management and their competency assessed to ensure people’s medicines were managed properly. Staff failed to see the significance of medicines stored in bedrooms that may not have been appropriate for the person residing there.
We found a number of infection control issues in the ground floor shower rooms, bedrooms and kitchen area. The staff had cleaning schedules in place. These described which areas were to be cleaned on any given day, as bedrooms were ‘deep’ cleaned on a rotational basis. There was also a policy and procedure for infection control, and staff had access to these documents. We found that staff did not have a working knowledge of either document, which meant that areas were not cleaned or disinfected in line with the policy.
Staff received an appropriate induction and on-going training for their job role, and all could speak a range of English and Asian languages. Staff had access to people’s care records and were knowledgeable about people’s needs that were important to them.
The management team and staff knew how to protect people under the Mental Capacity Act, 2005 and the Deprivation of Liberty Safeguard (DoLS). We observed that staff gained consent before care and support was provided. Staff followed the principles of the MCA Code of Practice which promoted people’s rights and choices about their care and treatment.
People were provided with a choice of meals that met people’s cultural and dietary needs. There were drinks and snacks available throughout the day and night. We saw staff supported people in their bedrooms who needed help to eat and drink in a sensitive manner. The catering staff were provided with up to date information about people’s dietary needs but not people’s special requirements. We found there was a lack of communication between the cook and care staff for people who had their food blended. Peoples’ food was blended to aid the persons swallowing where they had been assessed as having swallowing difficulties by a health professional.
People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives we spoke with were also complimentary about the staff and the care offered to their relatives.
We observed staff speak to, and assist people in a kind, caring and compassionate way, and people told us that care workers were polite, respectful and protected their privacy. We saw that people’s dignity and privacy was respected which promoted their wellbeing.
Staff had a good understanding of people’s care and cultural needs. People told us that they had developed good relationships with staff and were enabled to speak with them using their first language.
People are involved in the review of their care plan, and those that are not are happy for their relatives to be involved. We observed staff offered people everyday choices and respected their decisions. Staff spoke clearly to people, and explained what they were doing and where appropriate in the persons first language.
Some people chose to be involved with activities such as painting, puzzles, arts & crafts and finger nail painting. We saw a member of staff who was providing hand massages for people. We also spoke with a beautician who told us they attend the home once a month if anyone requests reflexology. That meant the staff consider people’s wellbeing.
People told us that they were able to pursue their hobbies and interests that was important to them. These included the opportunity to maintain contact with family and friends as visitors were welcome without undue restrictions. People were also able to have their cultural and religious needs recognised, for some this meant being dressed in culturally appropriate clothes and for others having their religious needs met. This protected people from social isolation.
Staff told us they had access to information about people’s care and support needs and what was important to people. Care staff were supported and trained to ensure their knowledge, skills and practice in the delivery of care was kept up to date. Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew it would be acted on.
The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals.
Staff sought appropriate medical advice and support from health care professionals. Care plans included the changes to peoples care and treatment, and people attended routine health checks.
People were confident to raise any issues, concerns or to make complaints. People said they felt staff listened to them and responded promptly.
People who used the service and their visiting relatives spoke positively about the open culture and communication with the staff. We noted that the provider interacted politely with people and they responded well to him. When we spoke to the provider, it was clear he knew people and their relatives, by the way in which they conversed.
The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours. However on the day we visited the staff rota had not been updated to reflect the changes to the staff on duty. That meant that the record had not been maintained properly in line with current legislation and guidance, and was not a true reflection of staffing on the day.
The provider understood their responsibilities and displayed a commitment to providing quality care through employing staff that were culturally appropriate. Care staff understood their roles and responsibilities and knew how to access support. Staff had access to people’s care plans and received regular updates about people’s care needs.
There were effective systems in place for monitoring of the building and equipment which meant people lived in an environment which was regularly maintained. However the internal audits and monitoring of the environment, and monitoring and consistency of people’s special dietary needs did not provide people with safety. Staff were aware of the reporting procedure for faults and repairs and had access to external contractors for maintenance and to manage any emergency repairs.