Background to this inspection
Updated
29 November 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 1 and 2 November 2016 and was unannounced. The inspection was undertaken by two inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using, or caring for someone who uses, this type of service.
The provider had completed a provider information return (PIR) before our previous inspection, so we did not ask them to resubmit this information. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We reviewed the information we held about the service. We looked at information received from relatives, the local authority commissioners and the statutory notifications the registered manager had sent us. A statutory notification is information about important events, which the provider is required to send to us by law. Commissioners are people who work to find appropriate care and support services, which are paid for by the local authority.
We spoke with 11 people and seven relatives about what it was like to live at the home. We spoke with four nurses, five care staff and six support staff about what it was like to work at the home. We spoke with the provider, registered manager and clinical lead nurse about their management of the service. We observed care and support being delivered in communal areas and we observed how people were supported at lunchtime.
Most of the people who lived at the home were not able to tell us in detail, about how they were cared for and supported because of their complex needs. However, we used the short observational framework tool (SOFI) to help us assess whether people’s needs were appropriately met and to identify if people experienced good standards of care. SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.
We reviewed four people’s care plans and daily records to see how their care and treatment was planned and delivered. We checked whether staff were recruited safely, and trained to deliver care and support appropriate to each person’s needs. We reviewed the results of the provider’s quality monitoring system to see what actions were taken and planned to improve the quality of the service.
Updated
29 November 2016
We inspected this service on 1 and 2 November 2016. The inspection was unannounced.
The service provides accommodation, nursing and personal care for up to 56 older people who may live with dementia. Fifty-one people were living at the home on the day of our inspection.
The registered manager had been in post for almost three years. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At our previous inspection in November 2015, we found a breach of the regulations, related to the number of skilled and experienced staff in post, which had an impact on all of the five questions we ask about services. We gave the home an overall rating of requires improvement and asked the provider to send us a report, to tell us how improvements were going to be made to the service. At this inspection, we checked whether the actions they had taken were effective.
Since our previous inspection, the registered manager had recruited additional staff. There were enough skilled and experienced staff on duty to meet people’s care and support needs safely and effectively.
The registered manager checked staff’s suitability to deliver care and support during the recruitment process. The premises were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.
People were safe from the risks of harm, because staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies.
The registered manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks. Accidents, incidents and falls were investigated and actions taken to minimise the risks of a re-occurrence.
People’s needs were met effectively because staff had the necessary skills and experience and received appropriate training and support. Staff understood people’s needs and abilities because they worked with experienced staff until they knew people well. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.
The registered manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). They had applied to the Supervisory Body for the authority to restrict people’s rights, choices or liberty in their best interests.
People were offered meals that were suitable for their individual dietary needs and met their preferences. They were supported to eat and drink according to their needs. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health.
People were cared for by kind and thoughtful staff who knew their individual preferences for care and their likes and dislikes. Care was planned to meet people’s individual needs and abilities and care plans were regularly reviewed and updated when people’s needs changed.
Staff were guided and supported in their practice by a management team that they liked and respected. Quality audits included reviews of people’s care plans and checks on medicines management and staff’s practice.
Some improvements had been made in record keeping since our previous inspection, but further improvements were needed. Individual records were not completed consistently or sufficiently detailed to evidence that staff took the necessary actions to minimise risks to people’s treatment and care. Audits of people’s care and treatment needed to be more robust.