18 July 2018
During a routine inspection
The inspection took place on 18 July 2018 and was announced.
There was a registered manager in post at the time of our inspection. 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.
We last inspected this service in November 2016 when we rated the service as Requires Improvement. There were two breaches of Regulations - Regulation 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were due to risk assessments not being updated to meet the changing needs of people using the service and no staff supervisions being completed. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. We used this inspection to check whether or not the provider had made the necessary improvements. At this inspection we found the service still had further work to do in order to meet a rating of Good.
The service did not record and monitor any accidents or incidents for patterns or trends. There was no business continuity plan in place for people in case of an emergency or disaster. Shortfalls were identified in the management of medicines as best practice guidance was not always followed. We also found there was no call monitoring system in place.
Staff and management had received training on Mental Capacity Act 2005 (MCA) but were found to have limited understanding of the principles of the MCA. Consent to care and treatment was always sought by staff.
There was a lack of robust quality assurance. Although the provider had auditing systems in place to monitor the quality and safety of the service, these were not always used effectively to scrutinise records or identify where improvements were needed.
Staff managed risks to people’s safely. Where incidents had occurred, the staff took appropriate action to keep people safe. Staff understood how to identify and respond to suspected abuse. Staff took appropriate measures to stop the spread of infection during their care. Robust checks and references were completed before any staff were employed by the service.
Staff treated people in a caring, considerate and respectful way. People told us that they felt staff were kind towards them. People's choices were considered in the delivery of care.
People were supported to prepare and eat food that they liked in line with their dietary requirements. Staff had sufficient training and supervision to carry out their roles. People's needs and choices were assessed and people were involved in important decisions and choices. Staff worked alongside healthcare professionals and other organisations to meet people's needs.
People's histories and care needs were included in their care plans which helped staff provide responsive care. There were sufficient numbers of staff to support people. People received personalised care that reflected their needs, interests and preferences. People had access to activities that reflected what was important to them. Regular reviews were undertaken and any changes to people's needs were actioned by staff. Staff communicated any changes in care with each other. The provider had a clear and accessible complaints procedure.
The registered manager worked alongside staff and was actively involved in people's care. No one was receiving end of life care at the time of our inspection. Systems were in place to involve people and staff in the running of the service. The provider considered other CQC reports and articles to assist with the service’s continuous development.
During our inspection we found two breaches 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.