We also saw from the records for other people and our audits of stocks of their medicines, that all medicines were being given as prescribed by the home or in the case of injections, by the community nurse.
We found that the home had developed their approach to working with people's consent and in their best interests. Although the service had introduced new a new assessment and care planning system it had not been sufficiently implemented to demonstrate compliance.
Some progress had been made with maintenance issues, but a health and safety audit highlighted a number of outstanding issues. The registered manager told us that a previous audit, carried out two years ago, had not been acted on. There were no plans to improve the suitability of the environment with regard to fixtures and fittings being old and worn.
The provider did not have a system in place to regularly assess and monitor the quality of service that people received. The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.
Although the service is registered to accommodate 17 people, there were only five people living at the service at the time of our inspection.
We found that people's privacy and dignity were respected but people's views and experiences were not fully taken into account in the way the service was provided and delivered in relation to their care. We found that where people did not have the capacity to consent, the provider had not made suitable arrangements to work with people's consent. Care was not planned and delivered according to assessed need and peoples' needs were not fully assessed or documented. We found that the provider had not taken steps to provide care in an environment that was adequately maintained. Some staff had not had the appropriate checks undertaken and the serviced lacked adequate domestic and administrative support. Staff were adequately supervised. The provider did not have effective systems in place to assess and monitor the quality of services that people receive.
People said they thought the home was 'lovely', 'home from home' 'clean, tidy and always warm'.
Care plans demonstrated that people receiving the care were involved in the planning of how and when this was delivered.
People who use services told us they were happy with the care they received, they liked the staff and felt they were well looked after.
People were seen to spend most of their day sitting in the lounge. There appeared to be less activities and stimulation for people than we had been seen on previous visits but people told us that they were having their needs met by staff who knew what they needed.
We were told by staff that a relatives/residents meeting had recently taken place where people had been given the opportunity to raise their views regarding their living arrangements and participate in making decisions about their future.
We were told that there was regular contact with family and friends both through visits and by telephone. One person was seen with a mobile phone which they said they used on a daily basis to talk to family members.
Visitors told us that staff were helpful and felt it was 'a good little home'.
We were told that they thought staff knew their jobs and 'although they were not pushovers they were very kind'. People said they felt people who use services were listened to and their relative would say if they were unhappy with something in the home.
We were told:
'they try their best, they are always smiling'
'I get up when I want and go to bed when I want to'
'the food is always very good and there is plenty of it'.
'I've got a lovely room, all my own things, it's warm and cosy, home from home'
Despite the positive feedback given by people who use services we had concerns regarding recruitment practices, staffing levels, management support, care plans and records.