In this report the name of a registered manager appeared who was not in post and not managing the regulatory activities at this location at the time of the inspection. This was because they were still a registered manager on our register at the time of this inspection. Following a scheduled inspection in February 2014 we found the home non-compliant with seven outcome areas. We issued four warning notices which required the provider to become compliant by 21 April 2014. We also made three compliance actions and asked the provider to tell us how they would become compliant with those areas. This inspection was to assess if the home had met the warning notices and complied with one of the compliance actions.
We spoke with eight of the 49 people at the home. We also spoke with nine relatives, members of the provider's management team and eight staff. We observed care in communal areas and viewed records relating to care, staffing and the management of the home.
We considered five outcomes during this inspection. These being
Outcome 4 Care and welfare of people who use services
Outcome 5 Meeting nutritional needs
Outcome 7 Safeguarding people who use services from abuse
Outcome 14 Requirements relating to workers
Outcome 16 Assessing and monitoring the quality of the service
We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.
Is the service safe?
People told us they were happy with the service they received. They said they had continuity of care with staff who knew what support they required. We also spoke with relatives and visitors who were also positive about the service and said they felt their relatives were safe. Staff had completed safeguarding of vulnerable adults and other essential training. They were able to tell us what they would do if they had any concerns about people's safety or welfare.
Risks to people's health and safety had been assessed and plans were in place to reduce these risks. We saw specific equipment had been identified in people's care plans, which was in place to reduce the risks and keep people safe. This included equipment such as pressure relieving mattresses and moving and handling equipment. Staff told us they had received training to use this equipment and we observed them being used correctly. People were receiving safe care and the warning notice in respect of safeguarding people who use the service had been met.
We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards. People's human rights were therefore properly recognised, respected and promoted.
Is the service effective?
People had individual care plans which identified their needs and how these should be met. Records of care, food and fluid provided showed people were receiving the care they needed. For example, people at high risk of pressure injuries were being assisted to reposition every two hours and equipment to support their pressure areas was in use. Staff had received training to ensure they had the skills necessary to care for people. They told us about the care they were providing for specific people which matched information in the person's care plan. The management team and staff were aware of who to contact for specialist advice and when this may be required. We saw specialist tissue viability nurses had been consulted for wound management advice.
We spoke with people and visitors, all of whom were positive about the service provided. Visitors said their relative's health needs were met and they were kept informed when medical professionals had attended. Therefore, the care provided was effective and people's needs were being met.
Is the service caring?
People were supported by kind and attentive staff. One person said 'this can't be better'. Visitors commented their relative was 'always well-dressed in co-ordinated colours and that staff took the time to put on her necklace'. Another relative said they felt they 'could not have chosen better'. A third visitor told us they visited virtually every day and they were very happy with the way their relative was treated. They added '[my relative] always took great care in their appearance' and they were pleased the staff 'took care' in how they were dressed now'. We saw care had been taken with a person's hair so that it did not become unnecessarily tangled when they were in bed.
Staff said they had time to meet people's identified needs and could provide care at times people wanted it. We observed staff interacting in a warm and friendly way with people. Before staff began to provide any care they always told people what was to happen. Staff used people's names and we observed the use of reassuring gestures such as touching a person's arm, hand or putting an arm around someone's shoulders.
Is the service responsive?
The service had responded promptly to address the concerns raised at the inspection in February 2014. Improvements to the environment had been made, staff had received training in moving and handling, safeguarding and dementia and procedures had been revised to ensure people were receiving the care they required.
The service was able to respond to people's daily needs. We observed call bells were answered promptly. One relative told us they had requested a room change for their relative and this was done within a week. We saw a person slide out of their chair at lunch time. Staff acted appropriately to check for any injuries. They used a suitable hoist to lift the person back into a chair. Plans and procedures were in place to manage unexpected events which could potentially interrupt the smooth running of the service.
Is the service well-led?
Since the inspection in February 2014 the registered manager had retired. The provider's management team has spent a considerable time at the home and addressed the concerns from the previous inspection. We were told a new manager had been appointed who was due to commence employment towards the end of June 2014.
Meetings with people and relatives have taken place. These have enabled the management team to keep everyone informed about proposed changes and improvements to the service. People and relatives were positive about the improvements. One relative commented on the 'big improvement in the d'cor in the rooms'. They were particularly pleased that their relative's 'room had been redecorated; it had new furniture and bed linen'.
A range of audits and procedures to monitor the quality of the service have been commenced. Where subsequent audits had occurred we saw action had been taken to address issues identified in the first audits. Staff and relatives told us they felt able to raise issues with the management team and knew they would be responded to.