We visited the location on 23 July 2012 to carry out a planned review. During this time we also checked to see if the registered manager and registered provider had made improvements to the service since our last visit. We then revisited the location on 2 August and 3 August following additional concerns being raised in respect of the staffing levels in the service.
During our visit on 23 July 2012 we used the Short Observational Framework for Inspection tool (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We carried out this observation for a period of one and a half hours.
During our first visit we also spoke with eight people using the service, seven relatives and six members of staff.
During our second visit we spent time observing the care and support that people received. We also spoke with five people using the service and five members of staff.
During the visit on 23 July 2012 our observations were more positive and we received feedback from people using the service telling us they felt there had been improvements. One person told us; 'It is very good, I am more than satisfied' and another said, 'Staff are helping me to compile a book of my life and I am really enjoying that, we have had some laughs. Nothing in life is perfect but it is pretty good here.'
We visited the service again on the evening of 2 August following the receipt of concerning information in relation to the level of care people were receiving. During this visit we found that people were not always supported as needed.
We arrived on the unit designated for people with a dementia related illness at 7.45pm and spoke with a member of staff on duty. The member of staff told us 15 of the 23 people using the service on this unit had been assisted by staff to go to bed. We looked around the unit and were able to speak with some people who we could see were in bed and awake. One person told us, 'I am not sleepy' and when we asked them why they were in bed they said, 'I don't know.'
During our visit on 23 July 2012 we found staffing levels had increased by one member of staff on each shift on the unit specifically designated for people with a dementia related illness.
Six people using the service did not express any concerns about the staffing levels and they offered the following comments; 'The staffing has improved, I ring my buzzer, I do not have to wait long,' and 'The staff pop into see me every hour, I am happy with this.'
Whereas two people said they felt that more staff were needed. Both of these people were based on the second floor.
We spoke with two relatives who were visiting on the unit designated for people with a dementia related illness. They both told us they knew staffing levels had been increased lately and said there seemed to be a better staff presence. Whereas two other relatives expressed concern about the staffing levels impacting on the care their relatives' received.
During our visit on 2 August 2012 our observations on the ground floor showed that one person had to wait for two members of staff to be available to assist them with their continence needs.
There were two members of staff on the unit designated for people with a dementia related illness. We found staff were task orientated and were unavailable at times to give assistance and support to people when they needed it.
One person said, 'Staff usually come within 10 minutes, but if it was an emergency I would need to shout my head off. The length of time I have to wait depends on the time of day. You have to ring the buzzer in the morning to get into the queue.' They also said, 'It doesn't work if there are only two staff, some people need two staff to help them. That leaves no one left to help anyone else.'
Another person said, 'I can go to bed and get up when I want. I do have to wait sometimes as the staff are too busy. I have been waiting now for the staff to come and change me, it was only about 10 minutes though. The staff do seem rushed off their feet.'
We made a safeguarding referral to Nottingham City Councils safeguarding vulnerable adult's team following this visit.