We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found:
Is the service safe?
We found the service to be safe because they had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns.
We observed that staff were competent and professional in their interactions with people who lived at the home. During our inspection we observed people were calm and appeared very content with the care and support provided.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have 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.
Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Care plans included a range of individual risk assessments and agreed actions for managing these risks. We saw risk assessments around specific behaviours which included triggers that may cause the behaviour as well as actions for staff to minimise these risks. However the provider may find it useful to note that these risk assessments did not detail the action staff should take should behaviours escalate.
People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We saw that all medicines had been stored securely and had only been administered by senior staff who had received training in the management and administration of medication. We observed staff during the administration of the lunch time medications. We saw staff administered medicines in accordance with the home's medication policy.
We observed that staff supported people to access the community in accordance with their plan of care. We saw that people were supported by appropriate numbers of staff.
Is the service effective?
We found the service to be effective because people's care treatment and support achieved good outcomes. We also found that people's rights and choices were respected by staff.
We saw staff recorded information about each person on a daily basis. Information included how people had spent their day and how they had responded to activities of daily living. This meant the effectiveness of people's care plans could be fully reviewed.
We saw that people's prescribed medicines had been regularly reviewed by their GP or specialist health care professional. This meant that people received medicines which were appropriate to their needs.
Staff used a range of methods to assist people to make choices about their day to day lives. Examples included objects of reference and photographs. We observed staff offering people choices in accordance with their needs and preferences.
The service was effective in promoting people's independence and community involvement. People were supported to engage in the local community in a variety of ways. Examples included trips out, home visits, shopping trips and activities.
Is the service caring?
Staff interacted with people in a gentle and kind manner. The majority of people were unable to communicate verbally with us. However we observed people responded in a positive way to the staff who supported them. For example one person smiled and held the staff members hand. Another person made a sound which indicated they were happy. One person told us 'all the staff are very kind. I don't have any favourite staff because they are all lovely. I like them all.'
The staff we spoke with had a very good understanding about the needs and preferences of the people they supported. They understood and responded to people's needs and requests where individuals were unable to make their wishes known verbally. This demonstrated that staff knew people well. A key worker had shared one person's wish to have 'a toy or teddy' with them. We observed the individual had a toy with them throughout our visit.
Is the service responsive?
The service was responsive to people's needs. We observed people were supported in accordance with their needs. For example, one person preferred to eat their lunch in a quiet environment. We observed this person being supported by staff in an area away from the other people who lived in the home.
Each person was allocated a keyworker who they would meet with on a regular basis. We saw the keyworker was involved in the review of people's care needs and preferences with other professionals.
Staffing levels and staff deployment had improved. We found there were sufficient numbers of staff on duty to meet people's needs. We also found a good mix of staff skills and experience. Senior staff were available on every shift and the home operated an on-call system. This meant that staff could contact either the manager or deputy manager outside of office hours.
People's health care needs were monitored and responded to appropriately. Information about people's health needs and contact with health and social care professionals had been recorded. We were informed that the service received good support from health and social care professionals and there were no problems obtaining their input for people when required.
Is the service well led?
The service was well led because there were systems in place which monitored the quality of the service provided.
People who lived in the home and their representatives were provided with opportunities to express a view about the quality of the service provided. We looked at some quality assurance surveys which had been completed by people's relatives. These showed a high level of satisfaction with all aspects of the service provided. Comments included 'thank you for providing an exceptionally high level of care' and 'I visit and phone regularly. I love visiting and I am always kept up to date.' Another person described the staff team as 'fantastic.'
A manager had recently been employed. They told us they were in the process of submitting an application to be registered with us. The manager was supported by a deputy manager and an administrator. We saw that senior staff were always available to support less experienced staff.
All the staff we spoke with were positive about the support they received and they confirmed that they received regular supervision sessions. Staff files contained detailed records of supervision sessions. These showed that staff received regular supervisions where their on-going performance and competencies were discussed.
We saw that staff had the opportunity to attend regular staff meetings. We looked at the minutes from a recent meeting. These showed that a range of topics had been discussed which included policies and procedures, staffing and information about the people they supported.
We found procedures were in place to minimise any risks to the people who lived at the home. Regular internal audits had been carried out which monitored the on-going health and safety of people. Internal audits included checks on the home's fire systems, environment, care planning and the management of people's medicines.