The purpose of this inspection was to review compliance with a warning notice for outcome 4 Care and welfare of people using services. This was issued following an inspection of the home on 30 November and 3 December 2013. A follow up inspection took place on 11 February 2014 and 14 February 2014 during which we found the home had not fully achieved compliance. This meant the warning notice was not lifted. We agreed with the providers we would allow them further time to achieve full compliance. During this inspection we also reviewed the following outcome areas because there were outstanding compliance actions, and because of information we had received since the last inspection '
' outcome 11: safety, availability and suitability of equipment
' outcome 13: staffing
' outcome 16: assessing and monitoring the quality of services provided
' outcome 21: records.
At the time of this inspection 24 people were accommodated at the home. The inspection was carried out by three inspectors over three days. We reviewed the care given to six people living in the home by reading their care records, by talking to people, relatives and staff and by observing staff interacting with people. We also spoke with nine people who lived in the home, 10 relatives and visitors a doctor, a community nurse, six members of staff and the registered manager. We also had e mail communication with a speech and language therapist. We carried out a short observational framework inspection (SOFI) during which we observed staff interaction with people at lunchtime, focussing specifically on three people. We carried out a short tour of the home, and checked records relating to the management of the home.
We considered our inspection findings to answer 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?
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
Is the service safe?
We found there were improvements in the way people's care needs were met since our last inspection. During the first two days of this inspection we found some records did not provide sufficient evidence to show how potential risks such as choking, moving and handling, and risk of falls had been assessed and reviewed. Actions to be taken to reduce the risks were not always clearly specified. The staff we spoke with demonstrated an understanding of each person's basic care needs but told us they had not read the care plans fully, relying on verbal handover. The manager told us they would take prompt action to improve the records and make sure staff read the care plans and understood the tasks they had to carry out. Therefore we returned to the home for a third day to see if this had been carried out. On this visit we saw checklists and new summary sheets had been put in place for each person explaining the care tasks to be undertaken, including tasks necessary to prevent or reduce risks. Despite these further improvements some records still contained conflicting information and had not been fully reviewed or not met consistently. Monitoring systems to check the records were improved, but there remained a risk some essential care needs may be missed.
Staffing levels had improved and at the time of this inspection we found there were sufficient staff on duty with the appropriate skills and experience required to ensure people's needs were safely met.
The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Health and social care professionals had been involved appropriately where people may have been deprived of their liberty due to the nature of their care needs. This meant that the home had acted in line with Deprivation of Liberty Safeguards legislation (DOL's). This legislation protects people's rights when they are unable to make decisions about their own welfare.
Is the service effective?
On the first two days of our inspection staff told us that systems to make sure essential daily routines were carried out had improved since our last inspection. They said there was good teamwork and staff were working together and communicating well.
We saw daily reports were completed by staff throughout the day providing evidence of the care people had received.
Is the service caring?
People told us the staff team understood the care they needed. They had been asked about their needs and had agreed their care plans. Comments included 'A gentleman sat and spent a lot of time asking questions about my care needs. They were all sensible questions. I am happy that my care plan is correct," and 'It feels so much like home ' it's friendly ' you are made to feel important. We can't speak highly enough of it here.'
People were supported by staff who were understanding and sensitive to their needs. We saw that staff offered choice and waited for responses. Relatives told us 'To be surrounded by so much caring is good for both her and myself" and 'Very happy the staff were giving the correct care'. We heard a relative speaking with a senior member of staff about the care their mother received during a period of serious illness and they talked about their confidence in the care provided by the staff.
We observed friendly, warm exchanges between people, visitors and staff. Staff were kind and attentive. We saw staff supporting people to walk around the home safely, staff taking people out into the garden, and people participating in activities in a cheerful, friendly and supportive atmosphere.
Is the service responsive?
The service was not fully responsive to people's needs and wishes. We saw that where people's needs had changed their care plan information had not always been updated. However, we saw evidence to show that systems for reviewing and updating care plans were improving, although not yet fully embedded. The staff we spoke with were able to explain to us how they had recognised signs of illness or distress or changes in care needs.
The staff worked closely with local health professionals and specialist advice, assessment and treatment had been sought promptly and where necessary.
Is the service well-led?
Where we saw some weaknesses in the monitoring systems during the first two days of our inspection the manager and staff took prompt action to make further improvements. On the third day we saw some further actions had been taken. However, due to the newness of these systems it was too soon to be sure they were fully effective.
People, their relatives, outside professionals and the staff were encouraged to provide feedback on the service. A suggestion box in the entrance hall encouraged people and visitors to give suggestions and ideas for improvements to the service. People and their relatives had been asked to complete questionnaires seeking their views on the quality of the service. Meetings were held between people living at the home, their relatives and staff which provided opportunities for issues to be raised and information to be shared.
You can see our judgements on the front page of this report.