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 caring?
We found from our observations and talking with people the service was caring. We observed staff treated each individual with dignity and respect. People told us how friendly staff were and how they felt staff listened to what they wanted. One person told us "staff always ask me what I want to do". We observed staff supporting people with care tasks such as assisting with meals. They did so in a dignified and caring manner. Interactions observed between people and care staff were supportive and respectful. Staff respected people's privacy and did not enter people's rooms without knocking and asking their permission to enter.
One person told us their relative was always made to feel welcome when they visited the home. A relative we spoke with told us "the staff are always friendly and I feel informed about the care my relative is receiving".
Is the service responsive?
We found the service responsive to people's wishes and choices and responded to the health and social care needs of individuals. People we spoke with told us their choices about how they spent their day were respected. People's preferences were actively sought and recorded as part of personal care planning. We were told currently people were being consulted about how breakfast was arranged as part of giving more choice to people. However we have noted how people were not able to have a bath if this was their preferred choice and the continued failure of the provider to resolve the lack of this facility.
Staff told us there was good communication and there were daily handovers so they felt informed about people's care needs. Staff told us if they had any concerns they would speak to the nurse in charge or the care manager.
The service was responsive to people's needs. Care plans we looked at contained assessments of need and outlined how needs would be met. The assessments were regularly reviewed to ensure they reflected people's up to date needs and preferences. We found where people had complex needs relating to their physical health, such as nutrition, professional advice and guidance was sought to ensure people's needs were met.
Is the service safe?
We found from what people told us and how the service responded to risks the service was safe. People who lived in the home told us they felt safe. One person told us "if I am unhappy about anything I will tell one of the carers they would do something about it". Another person told us "I know I can always make a compliant if I am really not happy about something. I am sure they would listen to me and do something about it".
The service identified, assessed and managed risks to the health, safety and welfare of people. People's care plans contained individual risk assessments to minimise these risks. Where people had moving and handling needs these were clearly specified so people were assisted in a safe manner.
We found there were improved arrangements to help ensure people were, as far as possible, safe from the risks to their health as a result of infections.
The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager said they had not needed to submit any Deprivation of Liberty Safeguards applications but they knew about the procedures to follow if an application was ever needed.
Is the service effective?
We found the service to be effective because people's care treatment and support achieved good outcomes. There was evidence of improved health for example where an individual had a pressure wound. The condition of the wound had significantly improved as a result of the care the person received. Another person's condition had improved to the extent they were now independent in having their meals and able to eat normally.
One person told us how coming to the home had been the best decisions she had made and how much their health had improved since living in the home. Another person went to their own home at night yet still retained their accommodation in the home and received care during the day.
We saw evidence of where people's health had improved in relation to treatment and care. In one instance this was the care of an individual who had a pressure wound. We saw where the service had referred individuals to specialists such as dietician and the mental health team. This enabled the service to support people with complex health and care needs so they could effectively meet those specific needs.
Is the service well led?
Currently this service has a manager who is not registered with the Care Quality Commission. There is also a care manager in place to support the manager in the provision of care. We found inconsistent practice in how the service was led in that there were failures to make the improvements we had previously identified. The provider and manager had clearly through its audits, improved guidance and communication with staff made real efforts to address failures in the quality of care. However shortfalls in record keeping continued from the previous inspection. The system put in place namely checking of food and fluid charts by nursing staff was not identified by managers as failing. Where people needed creams applied for skin conditions records of this care did not demonstrate this care was being consistently provided. This meant whilst managers reacted to the areas of non-compliance they had not ensured improvements had taken place and were sustained.
We found improvements had been made in the providing of individual supervision this ensured staff received this element of support. There were regular staff meetings and staff told us they found managers approachable and supportive.
There were comprehensive systems in place to monitor and audit the quality of the service. People views were sought about how they felt about the service they received. There were actions put in place and some improvements made as a result of external and internal audits. However there was a failure to identify through the audits undertaken shortfalls in practice around completion of records evidencing the consistency of care being provided. This showed these quality assurance systems were not effective or robust in identifying areas for improvement.