We carried out an unannounced comprehensive inspection on 26 June 2017.Underhill House Residential Home provides care without nursing for up to 28 older people who may be living with dementia. At the time of our inspection there were 27 people living at the service.
The provider was the 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 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 last inspection on 15 and16 March 2016 we asked the provider to make improvements to ensure people were protected from risks associated with their care and the environment, that people’s medicine were managed safely and to ensure people’s human rights were protected by the Mental Capacity Act 2005 (MCA). We also asked then to make improvements to how people's complaints were managed, and to how they assessed, monitored and improved the ongoing quality of the service. Following our inspection, the provider sent us an action plan telling us how they intended to meet the associated regulations. During this inspection we looked to see if improvements had been made and we found action had been taken.
People told us they felt safe living at the service. People were protected from abuse because staff understood what action to take if they suspected someone was being abused, mistreated or neglected. People were cared for by staff who, had been recruited safely to ensure they were suitable to work with vulnerable people. People were supported by suitable numbers of staff. People were supported by staff who had received training to be able to meet their needs.
People who had risks associated with their care had these managed appropriately to help ensure their ongoing safety. Accidents and incidents were recorded and assessed for themes and trends to help protect people and reduce the likelihood of re-occurrence.
People lived in an environment which had been assessed for risks. Fire tests were carried out and equipment was serviced in line with manufactures requirements. In some bathrooms, there was an unpleasant odour, this was because clinical waste bags had not been emptied. The provider told us they would take action and review how often bins were emptied.
People’s medicines were managed safely, and the provider’s processes followed best practice guidelines as set out by the National Institute for Clinical Excellence (NICE). However, people’s topical medicines (creams or gels) were not always dated upon opening, which meant there was a risk that they may be used past their expiry date. The provider explained they had spoken with staff about this, but told us they would re-look at their auditing processes to ensure medicines were dated appropriately. Staff at lunch time, were observed to not always be vigilant in ensuring when people had been given their medicines in their medicine pot that they had taken them. The provider told us she would speak with staff about the importance of observing medicines had been taken before medicine administration records (MARs) had been signed. Staff responsible for medicine administration, including night staff had received training and action was being taken to ensure staffs ongoing competence was assessed.
People's consent to care was sought and their human rights were protected. People had access to external health and social care professionals which helped to promote their ongoing health and wellbeing.
People told us they liked the meals and that there was always enough to eat. People were supported to eat and drink when necessary.
The provider had taken some action to ensure people living with dementia were supported and empowered by their environment, for example there was pictorial signage in place for the dining room, however not for all other areas. This meant people living with dementia may find it difficult to ordinate to their environment. We recommend that the provider takes account of dementia research to help create a more dementia friendly environment.
People and their relatives all, expressed how caring staff were, describing the service as being “Full of love”. Relatives told us it was a “Home from home”.
Staff knew people well, and spoke to people by their preferred name. Staff demonstrated a calm and patient approach and spoke fondly of the people they cared for.
People’s privacy and dignity was respected. People and their relatives felt involved in decisions relating to their care. Relatives were kept informed of any changes, and told us they had total trust in the staff to look after their loved one. People and their relatives were confident about who they would speak with if they had a complaint or issue.
Prior to moving into the service, people had a pre-assessment to help ensure the service could meet their needs. People received personalised care, and had care plans in place which were reflective of their individual needs. Care plans had been re-designed to help ensure staff had accurate information about how to meet people’s needs.
People could participate in social and wellbeing activities, including listening to musicians that visited on a regular basis, have manicures and go on trips out. The provider ensured the service remained in the heart of the community by inviting local schools into sing.
People’s religion was respected. The Catholic Church visited and other local churches had been asked to be part of the service.
The provider had introduced a new schedule of audits to help assess and monitor the ongoing quality of the service, and to help highlight when improvements were necessary.
People, their loved ones and staff told us, the people, were at the heart of the service. Staff told us the provider had high standards of which were adhered to.
People, and their loved ones views were gathered by the completion of satisfaction questionnaires to help ensure the service was run in line with people’s wishes and preferences.
The service was managed by the provider, as well as by a deputy manager who supported the day to running of the service. The provider was available and visible throughout the inspection.
People were protected by the provider's policies and procedures which had been updated to reflect changes to best practice guidelines. There was a whistle blowing policy which protected staff should they disclose poor practice and staff told us they would feel confident to speak with the provider if they had any concerns.
The provider demonstrated an open and transparent approach throughout our inspection this demonstrated their understanding and recognition of the Duty of Candour. The Duty of Candour means that a service must act in an open and transparent way in relation to care and treatment provided when things go wrong. The provider had not displayed their latest rating in line with legislation, but took immediate action to rectify this by the end of our inspection.
The provider worked in partnership with external professionals in order to continually improve the service.