The purpose of the inspection was to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with the manager, the provider, four members of staff, 16 people who used the service and six relatives. The inspector was accompanied by an expert by experience a person who has had experience of using services or caring for someone who uses this type of service.
Some people living in the home had a diagnosis of dementia. In order to understand their experiences we observed staff interactions with people over the course of our inspection.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
Care plans were person centred and detailed the individual's personal preferences and information to keep them safe. Risk assessments were seen covering all areas of daily living. This included mobilising, personal care, wound care management, eating and drinking. This meant that staff had guidance to support people safely. Staff described how they supported people in accordance with their care plan.
Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents. This minimised the risks to people and helped the service to improve and ensure people’s safety.
The manager told us there was no one presently accommodated that had been subject to an application for a Deprivation of Liberty Safeguard. (DoLS) However, owing to a recent Supreme Court ruling on the definition of deprivation they were reviewing this position. The manager told us that due to people having dementia that they would be making forty applications in respect of Deprivation of Liberty Safeguards. This was due to the people being under continuous supervision and control and they are not free to leave on their own accord. This meant that the provider took into consideration changes in legislation. In addition people’s safety was considered along with their human rights.
We saw that the home was clean and well maintained. People we spoke with told us that this was always the case. However, on the first day we found some areas of concern which included bathrooms being used as storage and sluices that were cluttered. This meant these areas were difficult to clean which potentially increased the risks relating to infection control. Some of the bins for the disposal of waste were not pedal action. This meant staff had to use their clean hands to open the bin. These were all addressed on the second day of our visit.
Is the service effective?
People’s health and care needs were assessed and a plan of care was put in place. Staff were aware of the needs of the individuals living in the home and how care was being delivered. Staff clearly described the impact that dementia may have on a person and how they were supporting people.
There were systems in place to monitor the effectiveness of the care. Care was reviewed to ensure that it was appropriate and suitable for the individual. Care was reviewed at three monthly intervals or as needs changed.
People’s care had been discussed at team meetings to ensure staff were following the care plans that were in place. Staff told us that daily handovers took place to ensure that important information was passed between staff to ensure that the care of people was planned and responsive to their needs. This meant the staff team were continually reviewing the care and support to ensure it was effective.
People were supported by staff that had received relevant training to support people effectively. This included training on supporting people with a diagnosis of dementia.
Is the service caring?
We observed staff meeting the needs of the people they were supporting. Staff were observed treating people respectfully, with kindness and patience.
People told us they were offered choices about the way their care was delivered. A relative told us "the staff are all really caring.”
Comments from people who used the service included “the staff are wonderful, nothing is too much trouble, it is like home from home”, “the home is fantastic I have no complaints and no suggestions for improvement, it is a really friendly place and I am happy”, “I like it here, I am settled and the staff are friendly, you only need ask and they respond” and “I feel safe here and I only need to ask any member of staff and they will respond to my request”.
Staff were attentive to people’s needs. Staff were knowledgeable about the people they were supporting including how their dementia impacted on their life.
We observed staff supporting people sensitively during the lunchtime. The meal was unrushed and people were offered a choice of main meal. Staff were observed interacting with people throughout the meal and responding to requests for assistance.
People’s daily routines had been recorded and care and support had been provided in accordance with people’s wishes. This meant that people were treated as individuals and their preferences were recognised.
Is the service responsive?
People had access to a variety of activities that were taken place daily. Care staff were observed providing activities to people in the home. Activities were tailored to the individuals including people with dementia.
People had access to other professionals including being registered with a local GP who visited the home on a weekly basis. A district nurse spoke positively about the care and support that was in place for people. They confirmed that staff were available to support them and that they had been kept informed of any changes to the persons' condition and wellbeing. They told us the staff followed their advice in relation to the treatment of the person.
Care files included information about how the staff were supporting people with their day to day care needs and staying healthy. The staff described how they supported and monitored people and where they were concerned this was discussed with the GP or the district nurse and relatives. This meant they were responsive to people’s changing needs and monitoring their general wellbeing. Two relatives told us the staff kept them informed of any concerns.
Is the service well-led?
There was a manager in the service that was registered with the Care Quality Commission. They told us they operated an open door policy. We observed people using the service, their relatives, staff and visiting professionals speaking with the manager about their care and support.
The service had a quality assurance system in place. The records that we looked at evidenced that where shortfalls had been identified these had been addressed. A relative told us they had responded to the survey and commented on a leak in a bathroom. They told us this was promptly resolved by the provider.
Regular staff meetings were being held to discuss the care needs and the running of the home. Where actions had been identified these had been followed up. This meant the staff’s views were valued and sought in improving the service.