All inspections: Smallwood - Care Quality Commission

At the time of our inspection there were five people living at Smallwood. We found that they received care that was personalised and tailored to their individual needs. People's care was planned carefully and staff were aware of potential risks to their welfare. People also had access to health care services outside of the home such as GPs, specialist nurses, speech and language therapists and psychologists to ensure their needs were met. We spoke with three people's relatives as part of our inspection. All the relatives we spoke with were positive about the care their family member received. Their comments included: "Yes, I do feel their needs are met...very much so. The home always looks to be flexible and proactive. I am very, very happy", and, "I have nothing but praise for Smallwood. I can't fault any of them."

People were supported to engage in activities at home and in the community with support from staff who knew them well. We found that there were enough staff to provide people with the individual support they required. The registered manager had put arrangements in place to promote consistency of care and ensure that staff had appropriate skills and experience to meet people's needs. Both staff and relatives of people who lived in the home told us that these arrangements were working well and had ensured that care was centred around each individual.

There were procedures in place to reduce the risks of abuse occurring in the home. Staff showed a good understanding of people's needs and rights and knew how to report concerns about people's welfare. We found that the home had communicated effectively with other agencies about risks which helped ensure that people were protected from harm. Relatives told us that there was a positive culture in the home of reflecting on incidents that had occurred and working out solutions in consultation with others. They felt that risks were managed well under the leadership of the registered manager and that, as a result, their family members were safe.

There were appropriate records in place about people's care and the running of the service. Records were located promptly when needed and were accessible to staff. This helped protect people from receiving inappropriate or unsafe care.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. On the day of inspection services were being provided to six people who were accommodated at the home.

Our inspection of 9 May 2012 found that people did not always experience care and support which met their needs. During this inspection we found that improvements had been made and support was delivered to meet people's needs by knowledgeable staff.

There were sufficient numbers of staff who had received appropriate training and support to provide the required services. Staff were aware of what constitutes abuse and the actions that would be necessary should abuse be suspected. People who were subject to physical restraint had appropriate assessments and plans.

The provider had undertaken quality assurance activity, such as unannounced visits from the area manager and monthly reviews of the service by the registered manager. Records relating to people did not always contain accurate information.

We used a number of different methods to help us understand the experiences of people using the service. People had complex needs which meant they were not able to tell us their experiences. We observed the support given to people, spoke with staff and looked at records relating to the delivery of care.

We saw that people were treated with consideration and respect and were supported to engage in a variety of activities within the home and in the community. Staff were aware of how to support people with their comfort and hygiene needs.

The provider had appropriate arrangements for the safe storage and administration of medication.

The provider continued to fail to ensure that people were safeguarded against the risks of excessive and unlawful restraint as staff had not received training and were unaware of the Deprivation of Liberty Safeguards. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. Staff were aware of how to report abuse but did not have adequate knowledge of whistle blowing.

The people using the service had complex needs which meant they were not able to tell us their experiences. As part of the inspection process we spoke on the telephone on 28 and 29 May 2012, with the relatives of five people.

One relative told us that the staff were very caring.

Two relatives told us that they had a say in how the care and support was delivered.

Three relatives told us that they felt Smallwood was a safe environment and staff were very open. They said that staff told them if any adverse incidents occurred involving their relative.

We saw one member of staff patiently and respectfully communicating with one person using a picture board to find out what they wanted to eat.

We saw another member of staff jumping up and down and laughing, as one person who lived in the home was walking by. The behaviour of the staff member was inappropriate and disrespectful as it appeared they were mimicking the person.

We heard two members of staff using inappropriate language when talking to people who lived in the home, for example 'darling' and referring to 'the boys' and another person was told they were 'cheeky'.

People living in the home had a variety of communication methods. People who were able to communicate verbally told us of their experiences. We observed care they received and interactions with staff.

People are involved in the care planning process as much as possible. Other health care professionals are involved in meeting care needs when required. People receive one to one care when their assessment of need shows that this is required.

People living in the home told us that they were able to choose how to spend their time. They can access a range of activities of their choice and are supported to develop independent living skills.

People are protected from harm by safeguarding procedures and challenging behaviours are appropriately managed.

People are supported by appropriate numbers of staff who are part of a core team that understands their needs and regular routines

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Smallwood

All Inspections

19 November 2013

During a routine inspection

31 October 2012

During an inspection looking at part of the service

23 July 2012

During an inspection looking at part of the service

9 May 2012

During an inspection in response to concerns

22 June 2011

During an inspection in response to concerns

Reports under our old system of regulation