We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.• Is the service safe?
• Is the service effective?
• Is the service caring?
• Is the service responsive?
• Is the service well-led?
This is a summary of what we found -
Is the service safe?
People were treated with respect and dignity by staff. People told us that staff treated them well. People were cared for by staff who were aware of the risks to their safety and health and staff knew how to support them in a safe way. A comment from a relative told us “I come in everyday and have watched everything and have found nothing untoward.”
Staff we spoke with told us that they had attended safeguarding training and knew how to recognise and report abuse. They demonstrated their understanding of safeguarding issues and their responsibilities in reporting concerns.
Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager had submitted a recent application and had been trained to understand when an application should be made. This meant that people were kept safe from harm. There were effective systems in place where people did not have capacity and best interest decisions were made through a multi-agency approach.
There were arrangements in place to deal with foreseeable emergencies. We observed that the home had clear protocols to follow in case of emergencies, such as an outbreak of fire, or when a person went missing.
Is the service effective?
People we spoke with told us that they were generally happy with the care they received and their care needs were met. It was clear from observations and from speaking with staff that they had a good understanding of people's care and treatment.
We found staffing levels had not always been maintained and additional cover organised when required. This meant that people's needs were not always met. Some of the comments we received from people were “all carers are lovely people and they talk to you and are respectful” and “this is a lovely home”. We received several comments about shortages of staff including “most of the staff try really hard but they are run ragged” and “the care is very good here but they are so busy. I don’t think there are enough staff”. People we spoke with also told us “the staff do try to come straight away but quite often I have to wait because I need to be moved by two people” and “the staff are very kind but so, so busy. They don’t have time to stop and chat”.
Comments from visitors spoken with were variable. We received positive comments when we were told “very happy with care, everything works so well”. Some other relatives told us they had raised concerns in the past about some of the care provided but that improvements were being made; while others had concerns about the staffing levels over weekends. We were told “there just aren’t enough staff here. It’s obvious”.
The records of care that staff provided to people were not always accurate. There were gaps in records relating to people’s nutrition and the support they received to reposition to prevent pressure damage. This increased the risk that people would receive inappropriate or unsafe care and treatment.
Is the service caring?
People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. They demonstrated their knowledge about the people they cared for and understood their preferences in consenting to how they liked things to be done.
We observed excellent interaction between people and staff who consistently took care to ask permission before intervening or assisting. There was a high level of engagement between people and staff. Consequently people, where possible, felt empowered to express their needs and receive appropriate care.
We saw people were receiving care in a sensitive way. We observed people being supported in making choices about their daily routines and the activities they would like to do.
Is the service responsive?
The service responded to people's changing needs through regular review of the care they received. People had been involved in the care they received. Their needs, preferences and interests had been documented to help plan an individual service. Staff spoken with told us they had enough information about people's needs and demonstrated their knowledge about individual needs and preferences.
There was evidence of good communication in the management of people's care between the provider and external professionals such as GP, speech and language therapists and hospital consultants.
People had access to activities that were meaningful and were supported to maintain relationships with their families.
Is the service well-led?
Quality assurance processes helped to make improvements to the quality of the service where they were needed. Actions were recorded and followed up at regular intervals. The processes in place to monitor and audit were being reviewed and improved to provide a person centred approach.
Staff had a good understanding about their roles and responsibilities. Although staff had been supervised through observation of their work practice, there were no formal supervision arrangements in place.