We carried out this inspection on 7 and 24 March 2016. The inspection was unannounced. The service is registered to provide care for up to 131 people and offers accommodation for people who require nursing or personal care. At the time of our inspection there were 114 people living at the service. The home is divided into two units, the Assisted Living area and the Reminiscence area, for people living with dementia.
A requirement of the service’s registration is that they have a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager had not been in post since October 2015.
A new manager had been in post since January 2016, and was in the process of applying for registration. We have referred to them as the ‘manager’ in the report. A temporary general manager was also employed managing the Reminiscence area of the home, and we have referred to them as the ‘general manager’ in the report.
We completed an unannounced focused inspection on 16 November 2015. This inspection was in response to concerns we received about how people’s care was managed. This included people who were at risk of falling and the management of people’s medicines. The inspection team visited the service and looked at two of the five questions we ask about services: is the service safe and is the service well-led. At this visit we identified a breach of regulation in relation to how the provider monitored and assessed the quality and safety of the service provided. Also a breach of regulation in relation to safe care and treatment of people in relation to the management of medicines, and in relation to staffing levels, and how staff were supported.
We visited this service again on 7 March 2016 following further concerns raised in relation to the management of medicines and the safety of the care provided. At this visit we found that some improvements had been made in the management of the service, however we continued to have concerns in relation to how people’s care was provided. At times, the quality and safety of care people received remained unsatisfactory and there were not always enough staff available to support people at the times required. We sent the provider a letter outlining the areas for urgent improvements. Following this, the provider sent us an action plan detailing how they would improve.
We returned to the service on 24 March 2016 to complete our inspection and also review the management of medicines. At this visit we reviewed the action plan that the provider had sent us in March 2016. We found that improvements had been made and actions had been taken in relation to most of the areas of concern. Where action had not yet been taken, the management team were able to show us plans to address the other areas of concern. Although some further improvements were still required, the provider was no longer in breach of the regulations in safe care and treatment of people, in relation to the management of medicines, and in relation to staffing levels. However, they were still in breach of the regulation in relation to how the provider monitored and assessed the quality and safety of the service provided, as these systems were not yet established.
At our visit on 7 March we had found people’s health and social care needs were not always reviewed regularly. Care records were not always completed by staff correctly. Staff told us this was because they did not always have time to do this. Risk assessments were completed, however plans did not consistently minimise the risks associated with people’s care.
Although more staff were being recruited, there was not always enough staff available to support people at the times they preferred. Staff were not always able to respond to people’s needs effectively and equipment was not always available when staff required this.
However, at our second visit on 24 March, the care records we checked had been completed correctly. Risk assessments had been reviewed by staff and updated to accurately reflect the risks to people and how they should be minimised. The management team had taken further steps to employ more staff and staff told us they were now starting to feel more positive about staffing levels, as the new staff started. New equipment had been ordered to support staff in supporting people with their care.
People’s nutritional needs were met and special dietary needs were catered for. However, at times staff were unaware of people’s dietary needs, which had the potential to place them at risk. Following this concern being raised by us, the management team arranged further training for staff to support them in this area.
Staff had training in order to meet people’s care and support needs. However, staff told us they felt they did not always benefit from computer training and that they would like further training in some areas, which the management team were now arranging.
People took part in some organised activities and trips, and told us there was plenty for them to do. It had previously been identified that activities could be further improved for people living with dementia and steps were being taken to address this.
People were treated with dignity and respect by staff when supporting them. Relatives were encouraged to be involved in supporting their family members.
People told us they liked living at the service and that most staff were kind and caring. People were cared for as individuals with their preferences and choices supported most of the time. However, people told us they did not always receive support from staff who knew them well.
People and staff were positive about the new management team and felt there had started to be some improvements at the service. The management team were beginning to make positive changes to the service people received.
Staff told us they felt supported by the new management team to carry out their roles effectively. Staff told us morale was beginning to improve at the service.
People told us they felt safe living at the service. Staff knew how to safeguard people and what to do if they suspected abuse. Checks were completed prior to staff starting work at the service to make sure they were of good character and to ensure their suitability for employment.
People were protected from harm as medicines were stored securely and systems ensured people received their medicines as prescribed.
Staff referred to other health professionals when needed, so people were supported to maintain their health and wellbeing.
Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). Staff ensured they gained consent from people before supporting them with care.
The manager was responsive to people’s feedback in developing the service, and making continued improvements, such as recruiting more staff, supporting staff further, ensuring people received care that met their needs and that this was accurately documented. Systems and checks made sure the environment was safe. People knew how to complain if they wished to, and complaints were being recorded and responded to by the management team in a timely way.
The provider had displayed their last inspection ratings, as is the legal requirement to do this.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.