The inspection was carried out by one Inspector over seven and a half hours. During this time we talked with 14 people who were living in the home, and observed staff carrying out care duties with other people. We talked with 13 staff and met other staff briefly; and talked with three relatives, three health professionals and a visiting GP. The manager and deputy manager were present throughout the inspection and assisted us by providing documentation for us to view.We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?
Is the service safe?
We viewed all areas of the premises and saw that they were well maintained and visibly clean in all areas. We talked with housekeeping staff and found there were daily cleaning programmes in place and deep cleaning programmes to ensure that good infection control practices were maintained. A relative told us that they were 'Always struck by the cleanliness of the home.'
We talked with people on each floor and spent time carrying out an observational inspection on the first floor. The Short Observational Framework Inspection (SOFI) is a method for observing people's care when they are unable to give clear verbal feedback. We saw that staff were kind and attentive, and treated people with respect and dignity.
We found that the home had comprehensive procedures in place to check that people had consented to the care and treatment provided for them. People who lacked the mental capacity to make decisions about where they lived or the care that they needed had been appropriately supported by their family members or advocates, and by health and social care professionals, to make decisions on their behalf and in their best interests. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that people who lacked full mental capacity were appropriately represented by people who knew their previous wishes and decisions.
We saw confirmation that all of the staff had been trained in safeguarding vulnerable adults. We spoke to staff who gave clear explanations of the different types of abuse to be aware of, and who knew the action to take in the event of any suspicion of abuse. The manager and senior staff were informed about their responsibilities to report any safeguarding concerns, and liaised with the local authority safeguarding team for any support or advice.
Is it effective?
We viewed care plans on each floor and saw that people or their representatives had been involved in all aspects of their care planning. The care plans covered all aspects of people's care and treatment, and had associated risk assessments. We saw that people's preferences were recorded and were adhered to in regards to their individual care.
The home included a floor for people receiving rehabilitation and short term care after being in hospital. This floor had NHS staff as well as nursing and care staff employed by the home. The NHS staff were health professionals who carried out physiotherapy and occupational therapy; and Social Services care managers who arranged for people's placements or return home after their period of rehabilitation. We saw that the staff liaised with each other throughout the day so that there was good communication between them about people's care. The staff appropriately arranged for referrals to other health and social care professionals for people who were receiving long term care.
We viewed training records and saw that staff kept up to date with required training courses, and carried out other training which was relevant to their individual job roles. This meant that they were able to provide effective care and support.
Is the service caring?
All of the people that we spoke with, and relatives, spoke highly of the staff and the care they received in the home. People's comments included, 'The nurses and care staff are outstanding. They have to deal with all sorts of things. It is very good here'; 'It's very, very good, the staff are lovely'; and 'The care has been brilliant. The staff are excellent. I am so pleased with the progress I have made.'
We saw that care plans identified people's own preferences, such as the name they preferred to be called by. We observed that staff offered people a variety of choices in regards to food and drinks; and in where they wanted to go, and what they wanted to do.
We saw that staff took time to listen to people and did not rush them for answers. They included people who appeared withdrawn in the activities going on around them, and drew them gently into conversations so that they did not feel isolated.
Is the service responsive?
The home employed an activities co-ordinator who arranged for a variety of different activities to be available. We saw that care staff also took part in assisting people with activities during the day of our visit. This included people joining in with games and quizzes; and taking some people outside to sit in the garden.
We saw that there were on-going assessments and care plan reviews to ensure that people's changing needs were identified and addressed. This was especially important on the second floor, as people having rehabilitation often made daily progress, which changed their care planning. We saw that the health professionals gave clear directions, so that nursing and care staff knew how to assist people with their mobility and daily living tasks.
People said that if they had any concerns they were able to raise them with the manager and the staff. The manager and deputy were available throughout the week, and people said that they were confident that if they had any concerns or complaints that these would be dealt with appropriately. A relative said that the staff always informed them of any changes in the person's care plan, and would contact them if they had concerns about their health needs.
People's views were obtained through using questionnaires and through residents and relatives' meetings. We saw that the responses were collated, and action was taken to address any issues raised. The results were given to people at the next meeting.
Is the service well-led?
Staff said that they worked well together as a team and were supported by the management structure. We saw that they interacted well with each other as well as with the people living in the home. Each floor had a nurse on duty who provided an overall lead for the floor. The manager and deputy manager provided daily support working alongside the nursing and care staff.
Staff had individual supervision with their heads of department, which enabled them to discuss any training needs or raise any issues. They were also supported through yearly appraisals and monthly team meetings.
We saw that the manager provided a clear lead for the other staff in the home. There were systems in place to monitor the home's progress, which included weekly and monthly audits for areas such as medication and care plans; and other audits for infection control; health and safety; staff training; housekeeping; laundry services and kitchen management. We saw that there was a yearly audit for how well people living in the home were involved in the running of the home, and this had scored 100 per cent at the last review.