We carried out an inspection on 28 August 2013 and found that the provider was not meeting the regulations for cleanliness and infection control, management of medicines and records. The provider wrote to us and told us what actions they were going to take to improve. During this, our latest inspection, we looked to see what actions had been taken. We carried out this inspection so that we could answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
From our previous inspection significant action had been taken to improve the service to people. There are still improvements to be made.
Below is a summary of what we found. The summary is based on our observations during the inspection, discussions we had with three people who lived at the home, two members of staff who supported people, the deputy manager and the registered manager. We looked at three people's care records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We found that systems were in place to support learning from events like accidents, incidents and complaints. We spoke with people who told us they were able to raise concerns. One person said, "If I need to I will speak to staff or the manager".
We found that risk assessments were in place to manage any potential risks. People's care and welfare were an important part of the service people received. Our observations were that people were able to access fluids regularly throughout the day and staff were proactive in ensuring people were not dehydrated.
We found that people's medication administration record (MAR) charts were much better at showing whether people had been given their medicines and processes were in place to guide staff when using 'as required' medicines.
People we spoke with told us they felt safe living in the home. We found that there was no second stair rail to support people up and down the stairs. People clearly needed an additional rail to support them up and down the stairs and keep them safe from harm.
No applications for the Deprivation of Liberty Safeguards had been submitted by the service. Training records showed that training was available in the Deprivation of Liberty Safeguards (DoLS), but only the manager and deputy manager had completed the training. There was no record of the Mental Capacity Act (MCA) training being delivered. Staff we spoke with had a very limited understanding of both areas of training.
We raised concern with the manager about the risks to people's safety from the slightly raised flooring along the main corridor to the dining area from people tripping or falling.
We have asked the provider to tell us what improvements they will make in relation to ensuring the service is safe to meet people's needs.
Is the service effective?
We found that people's current needs were being identified through up to date reviews, so if people's needs changed staff would know how to meet their needs. Documentations were in place to highlight to staff where there were potential risks to how people's needs were being met.
Records had improved since out last inspection, but there were still some concerns with how staff recorded when they had cleaned the home and whether audits carried out by managers were effective. We found gaps in cleaning schedules, which audits did not pick up and we could not be sure that the environment was being cleaned regularly.
Systems were in place to ensure checks were carried out on the quality of the service people received. The provider ensured people were able to share their views on the service so improvements could be made.
People told us that staff were, "Caring" and "Kind". One person said, "Staff do take us out on trips regularly".
Overall we found that the provider had systems in place to ensure people's needs were being assessed and any changes to people's needs could be identified. However we asked the provider to tell us what improvements they would make to ensure audits carried out were effective.
Is the service caring?
Staff we spoke with had a good understanding of people's needs. We observed staff interacting with people in a caring and supportive manner. Staff spent time to sit and talk with people, we saw staff dancing, and having a laugh with people. Staff were constantly asking people if they were okay and checking on people in their rooms constantly to see if there was anything they wanted. One person said, "I like living here. I can do what I want and there is no fuss".
People's preferences were recorded on their care records. One person had on their record that they were a keen gardener, so staff encouraged them with gardening. People were able to take part in activities from our observations or just sit and watch the television. One person said, "I like just sitting in my room and watch the world go by".
The provider had adequate systems in place to meet the requirements of the law in ensuring the service was caring.
Is the service responsive?
We found that from our previous inspection the provider took action as required to improve the service to people. We found that there were still areas to be improved but the provider was aware of these and actions were ongoing.
The provider listened to what people and their relatives said about the service. As a result of people's views the provider was decorating the home and having new carpet throughout. This was from a direct concern raised by people through a questionnaire.
The provider had adequate systems in place to meet the requirements of the law in ensuring the service was responsive to people's needs.
Is the service well-led?
The service was managed by a registered manager who was supportive throughout the inspection. People we spoke with told us if they had any concerns they could speak to the manager.
We found that a number of audits were regularly being carried out to ensure the service people received were of a high standard. These were not always effective in identifying areas of concern, but the manager was committed to improving the service.
The action taken by the manager to improve the environment of the home and people's bedrooms as a result of the concerns raised through the questionnaire process, showed willingness to improve the home.
The provider had adequate systems in place to meet the requirements of the law in ensuring the service was well-led.