This was an unannounced inspection that took place on 23 October and 25 October 2017. The service provides accommodation with nursing and personal care for up to 50 people, some of whom may be living with mental health and dementia related conditions. Bedrooms are on the ground and first floor and are all single occupancy. There are communal lounges, a dining room and activity areas on the ground floor. There is a garden to the rear of the property. There were 39 people living at the service when we inspected.
People were living with a range of care and nursing needs, many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more independent and needed less support from staff.
We last inspected this service in October 2016. Breaches of regulations were found. We issued requirement notices in relation to safe care and treatment, medicines management and shortfalls in keeping accurate and up to date records. We asked the provider to take action. The registered manager sent us an action plan telling us what action they would take to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found improvements had been made but there were continued breaches of the regulations.
Since the last inspection the registered manager had left the service. There was no registered manager working at the service at the time of this visit. 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 and associated Regulations about how the service is run. There was a manager in post who had applied to register with the CQC and was awaiting their fit person’s interview. The manager was supported by a nurse manager, and team of clinical nursing staff and care staff.
The manager told us there was still issues with the electronic computerised system they were using which collated all the information about the care and support that people needed. Information about people had been transferred to the electronic system including care plans and risk assessments. However the system was not formulating all the information needed to make sure there was an accurate account and guidance of the care and support people needed. The manager and other staff had highlighted their concerns to the provider about the electronic system and they were working together to improve its efficiency. In the meantime some records were not accurate.
Risks had been identified and assessed for people's health and welfare but full guidance to make sure all staff knew what action to take to keep people safe and manage risks was not always available. Staff knew people well and were able to explain what action they would take to make sure risks to people were mitigated. However, when new staff were working or when agency staff were covering there was a risk of people not receiving the interventions they needed to keep them as safe as possible.
Before people decided to move into the service their support needs were assessed by the manager or nurse manager to make sure they would be able to offer them the care that they needed. The care and support needs of each person were different and each person’s care plan was personal to them. The care plans were written to inform staff about how people preferred to be supported and cared for.
Improvements had been made to make sure people received their medicines safely and when they needed them, however there were areas that needed further improvement. These areas included ‘as and when’ medicines that were given covertly and keeping accurate records of when creams and ointments were applied.
Staff understood how to keep people safe and protect them from the risk of abuse. They were aware of how to recognise and report safeguarding concerns both within the service and to outside agencies such as the local authority safeguarding team. Staff were confident to whistle-blow to the manager if they had any concerns, and
were confident that appropriate action would then be taken.
The management and staff knew how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests Deprivation of Liberty Safeguards (DoLS) had been applied for by the manager when it was necessary.
People were supported to have a nutritious diet. Their nutritional needs were monitored and appropriate referrals were made to specialist teams such as dieticians when it was necessary. The staff were effective in monitoring people's health needs and sought professional advice when it was required. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.
Staff were familiar with people's life stories and were very knowledgeable about people's likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively. Staff understood people's specific needs and had good relationships with them. Most of the time people were settled, happy and contented. Throughout the inspection people were treated with dignity and kindness. People's privacy was respected and they were able to make choices about their day to day lives. When people became anxious staff took time to sit and talk with them until they became settled. People were encouraged and supported to join in with activities.
People's confidentiality was respected and their records were stored securely.
The complaints procedure was available and accessible. People, relatives and staff knew how to complain and the majority felt confident their complaints would be listened to and acted on. People had opportunities to provide feedback about the service provided both informally and formally.
There were enough staff to meet people's needs and staff had received appropriate training and support to help them carry out their roles effectively. Recruitment processes had been followed to ensure staff were suitable for their role. All staff had received regular one to one meetings with a senior member of the staff team. The registered nurses practises were monitored and they also received clinical supervision from the management team.
Staff had completed induction training when they started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.
There were regular health and safety checks of the environment to make sure everything was in good working order. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. There were regular fire drills at the service so that people knew how to leave the building safely. People's personal evacuation emergency plans (PEEPS) had been reviewed and updated to explain what individual support people needed to leave the building safely.
People, relatives, visiting professionals and staff felt the management of the service had greatly improved. They said the manager and management team were approachable and supportive and that they listened and took action when they needed to. The manager had full oversight and scrutiny of the service. They knew what was going well and the areas that needed improvement. The manager had sought feedback from people, staff and others involved with the service. Their opinions had been captured, and analysed to promote and drive improvements within the service. Informal feedback from people, their relatives and healthcare professionals was encouraged and acted on whenever possible.
Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.
It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had conspicuously displayed their rating at the service and on their website.