The inspection took place on 17 November 2015 and was unannounced. The inspection continued on 19 and 20 November.
The service is registered to provide personal care with accommodation for up to 22 adults. The service has 22 ensuite bedrooms some with walk in showers and others with baths. The service has a large open plan living and dining area that people are free to use at any time. The living area overlooks a patio area which leads into a level access garden. The accommodation is over two floors and the first floor can be accessed by two stair lifts or a passenger lift. Each room has a call bell so that people can call for help when needed. There is a fully equipped hairdressing salon situated on the ground floor.
The service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission 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 2008 and associated Regulations about how the service is run.
People told us that they felt safe living at the service, one person told us, “I’ve had a lovely life and now I’m here which is great”. A health professional told us, “People are safe here due to staff attention, retention and their caring nature. It makes a difference and I can see that”. Staff were able to tell us how they would recognise if someone was being abused and what they would do. Staff told us that they had received safeguarding training and the training records we reviewed confirmed this.
There were policies in place for a number of areas such as safeguarding, complaints, behaviour that challenges the service and whistleblowing however, they were reflective of the old Essential Standards and Regulations. We raised this with the registered manager who agreed to review and update the services policies.
Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they choose to live their lives. Each person had a care file which also included individual assessments and guidelines to make sure staff supported people in a way they preferred. Risk assessments were also completed, regularly reviewed and up to date.
Each person had a personal emergency evacuation plan in place which detailed how people were to be supported in the event of an emergency. These plans were regularly reviewed and up to date. There was also an emergency contingency plan in place which had details of what staff should do to keep people safe in the event of a failure of service for example a gas leak, numerous staff sickness and failure of electric to name a few.
Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained to give medicines.
Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example dementia, pressure area care, nutrition and diabetes. Some people staff were supporting presented behaviour which challenged the service however; only two out of 15 staff had received training in this. Staff told us that they would find this training useful.
People had a capacity assessment in place and care files we reviewed showed evidence of best interest meetings taking place. Staff were aware of the Mental Capacity Act. Deprivation of Liberty Safeguards applications have been completed for everyone and these have been sent off to the Local Authority.
People and relatives said that the food was good. One relative told us, “Food is brilliant. The chef is very good. There are certain things mum can’t eat, they accommodate this”. The majority of people ate their meals in the dining area and staff ate with them. People who were supported in their rooms had isolation charts in place which recorded their fluid and food intake. Most meals cooked are homemade and those cooked on the days of the inspection looked and smelt very appetising.
People and relatives told us that the service was caring. One person told us, “Staff are very good, helpful and have a friendly manner”. A relative told us, “The care for my mum is spot on”. Staff acknowledged people as they entered the room and communicated with them at eye level rather than standing over them. Staff told us how they liked to be able to spend quality time with people to have conversations and do activities with them. People’s privacy and dignity was respected, if people required support with personal care they were supported discretely back to their rooms and doors were closed. One relative told us, “they are always treating her with upmost dignity”.
Peoples care files had admission assessments in place and the information from these formed the foundation of their individual care plans, individual assessments and support guidelines for staff to follow. There was evidence that these were regularly reviewed in response to peoples changing needs. A relative told us, “Mum gets all the care she needs. It is a bit more difficult as she has dementia and can’t tell them. But staff pick up on it and respond to her”.
The service carried out annual feedback questionnaires which are sent to families, health professionals, staff and people who have capacity to understand them. Feedback is gathered and outcome letters are sent back out. There was no evidence of an action plan in response to feedback collected. The responsible individual told us that outcome and actions are generally discussed and acted upon informally and not recorded. A relative told us, “There is a survey once a year. We have informal discussions about results”. Overall the feedback reviewed during the inspection for 2014/15 was very good.
Complaints were recorded and acted upon quickly with an average turnaround of 48 hours from those reviewed. A relative told us “I have raised concerns once or twice and these issues have been sorted straight away”.
People, staff, relatives and health professionals all said that they felt the home was well managed. One relative told us, “The manager is always accessible and takes note of what I ask”. The manager encourages an open working environment for example, we observed on several occasions staff coming up to them or visiting the office to discuss matters with her.
The responsible individual carried out annual quality audits which covered areas such as health and safety, infection control, accidents and incidents, environment and a planned programme of maintenance and replacement. There has been a lot of investment put into the service making the living environment safer and homely for people to live in. A health professional told us, “I have been coming here for 10 years and have seen great transformation here”.