The inspection took place on 23 and 24 November 2015, and was an unannounced inspection. The previous inspection on 4 December 2013 found no breaches in the legal requirements.
The service is registered to provide accommodation and personal care for up to 37 older people who are living with dementia. At the time of this inspection there were 29 people receiving the service. The service is called Walmer Care Centre and consists of two detached properties that share the same driveway. The premises are known as Carleton Lodge and Carleton Mead. Each person has a single room and there are communal lounges with a separate dining room in each of the premises. The service is situated on the seafront of Walmer with unrestricted views over the coast. At the time of the inspection in Carleton Lodge there were fifteen people receiving a service and fourteen people at Carleton Mead.
The service has an established registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Potential risks to people were identified regarding moving and handling, but full guidance on how to safely manage the associated risks were not always available. In some cases there were no risk assessments in place, for example when people were receiving support to be moved with a hoist, or taking a bath. There was also no guidance in place for staff to follow when using equipment, such as handling belts and slide sheets.
Medicines were stored and administered safely. However, people did not always receive their medicines in line with safe infection control procedures because of the way some staff handled the medicines.
People felt safe in the service. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe. They were aware of the actions to
take in the event of abuse and policies and procedures were in place to give guidance on what actions to take.
Records of accident and incidents showed that action was promptly taken to prevent further re-occurrence. Appropriate servicing and safety checks had been undertaken to ensure the premises were safe. Fire drills were held and environmental risk assessments were in place. Plans were in place in the event of an emergency.
Some refurbishment of the premises had been carried out and plans were in place to improve the environment. A maintenance plan was in place to address areas that still required attention.
People’s rooms were personalised to their individual preferences.
We observed that people were comfortable in the presence of staff. Staff were compassionate, patient and caring, and ensured that people received the care they needed. The registered manager used an assessment tool to ensure there was enough staff on duty at all times. Staff were recruited safely and there was a structured training programme to ensure that staff had the skills and competencies to carry out their roles.
People were supported to make their own decisions and choices, and these were respected by staff. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which apply to care homes. The manager understood when an application should be made and some people had authorised restrictions in place to ensure that the decision about the restriction had been made in their best interests and was lawful.
People had choices of food, and specialist diets were catered for. Staff understood people’s likes and dislikes, dietary requirements and promoted people to eat a healthy diet.
People were supported to maintain good health and received medical attention when they needed to. Appropriate referrals to health care professionals were made when required.
Staff treated people with kindness, encouraged their independence and responded to their needs. People and relatives told us that staff were respectful and their privacy and dignity was maintained.
People and relatives had been involved in the care planning process. Care plans had been regularly updated and relatives told us that they were invited to the care plan reviews when required. The registered manager had recognised that the care plans needed to be more personalised and there was an action plan in place to achieve this.
People had a varied programme of suitable leisure activities as each person had their own personalised activity plans, which were detailed about their life and interests. Visitors were made welcome in the service and were able to visit at any time.
There was a complaints procedure in place, which was on display so that people were aware how to complain. There had been no formal complaints received about the service.
The service sought feedback from people their relatives, staff and health care professionals about the overall quality of the service. Audits and health and safety checks were regularly carried out to ensure the service was safe.
We made a recommendation about medicines administration.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.