We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
Below is a summary of what we found '
Is the service caring?
We saw people's needs were assessed and care was planned in line with their assessed needs. People we spoke with said," The care is very good, they look after us well" and 'I've been here five years and I wouldn't stay if I didn't think it was any good.'
We observed staff delivering care and noted that they were patient and compassionate and supported people to be as independent as possible or addressed people's needs where they were unable to do so themselves.
People we spoke with told us that a range of activities took place and that trips out of the home were arranged. One person told us, 'There are activities, yes. You can choose if you go or not. I would have been down there today but I've had visitors.' We saw people who used the service having their nails painted and an activity in the afternoon where some people made small felt bags for Easter. This meant there were a range of activities available to keep people active and mentally stimulated.
Is the service responsive?
People's needs were assessed and their care plans reviewed and revised in line with the changing needs. People had access to a range of outside services to ensure their health and wellbeing was maintained including doctors, dentists and opticians.
We observed staff delivering care and found that they supported people appropriately and responded to people's individual needs. People were offered a choice of meals and particular nutritional needs, such as special diets and food likes and dislikes were catered for. People we spoke with told us that they food was good. One person told us, 'There is a choice of what you can have; not every time, but usually. There are plenty of drinks.'
We saw that complaints and safeguarding incidents were investigated and, where necessary, action taken to change or improve care delivery.
Is the service safe?
People were cared for in an environment that was safe and well maintained. Fire and safety systems were regularly checked and fire drills undertaken. People had individual personal emergency evacuation plans which detailed the help they would need if there was a fire or similar event.
Systems to record and monitor medicines were incomplete or contained errors. Records to indicate why people had not been given certain medications were not always complete, there was an error on one person's record for medication used to thin the blood and a number of people did not have care plans for 'as required' medication. Some hand written entries on the medication record sheet were not clear. A daily audit of medicine records had not picked up any of the issues we found. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst the manager told us that no applications have needed to be submitted, people's care plans reflected that these issues had been considered and indicated that appropriate actions or best interest meetings would be held if the need arose. Nursing staff within the home had received training on DoLS and the Mental Capacity Act 2005.
Is the service effective?
People told us they were happy with the care that had been delivered and their needs had been met. One person who used the service told us, "The care is very good. The care workers are very good, too.' It was clear from our observation and from speaking to staff, that they understood people's care and support needs. One staff member told us, 'It's a good bunch of carers here and the nurses are good.' We observed several members of staff delivering care and saw that it matched the actions outlined in people's care plans.
People nutritional needs were assessed and food and drink was supplied, taking into account individual needs and preferences. The cook for the home had a good understanding of people's individual nutritional requirements. People's weight was regularly monitored and, where there was concern about possible weight loss additional advice was sought. One person told us, 'The food is very good. It must be as I've put on quite a bit of weight.'
Is the service well led?
The home had a range of quality assurance system in place to monitor the quality and consistency of care. The manager carried out a range of checks and audits. We saw copies of documents regarding checks on medication, care records, nutrition, equipment and the general environment within the home.
People who used the service confirmed that there were regular residents' meetings and we saw copies of minutes from this meeting. One person we spoke with told us that they were able to raise issues in the meetings. They told us, 'Generally things are OK; but I would tell them if it wasn't any good.'
Staff confirmed that there were regular staff meetings and we saw minutes from these meeting. Staff told us, and records confirmed that they had regular supervision with a senior member of staff and yearly appraisals. One staff member told us, 'Yes, we get supervision every three months, although sometimes more frequently. We can talk about care needs and issues or training.'