Background to this inspection
Updated
16 May 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.
This service was previously inspected in November 2016. At that time we found there were areas that required improvement. This inspection was conducted over two days by one adult social care inspector.
Prior to the inspection we looked at information we had about the service. This information included the statutory notifications that the provider had sent to CQC. A notification is information about important events which the service is required to send us by law.
Before the inspection, we had asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they planned to make. We reviewed the information included in the PIR and used it to assist in our planning of the inspection.
During our visits we spoke with six people individually and two relatives. In addition we observed people in communal areas. We spent time with the manager, deputy, six care staff, the cook, domestic assistant and maintenance operative. The regional manager and regional support manager also attended the first day of our inspection to support the manager, introduce themselves to us and answer any questions we had. We observed lunch and staff interaction with people. We looked at four people’s care records, together with other records relating to their care and the running of the service. This included staff employment records, policies and procedures, audits and quality assurance reports.
After our inspection the manager sent us a reflective account on her progress and future plans following her first three months at the home. In addition the activity co-ordinator who was not available during our visits also wrote to us to share her thoughts and feelings since commencing her new post.
Updated
16 May 2018
At our last inspection in November 2016 we rated the service overall as Requires Improvement. This was because we found breaches in Regulations 9, 12 and 14 of the Health and Social Care (Regulated Activities) Regulations 2014. This was because medicines were not consistently managed safely, people’s nutrition and hydration needs were not consistently met and care plans did not always accurately reflect people’s needs and their involvement in developing them.
Following the inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of those regulations. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. In addition they had sustained previous good practice. As a result of this inspection the service has an overall rating of Good.
Why the service is rated Good.
Even though the new manager had been in post for a short period of time their appointment had already significantly helped improve the service. Their previous experience and support from their managers had equipped them with the skills and knowledge required for their roles and responsibilities. It was evident they were confident and committed to embrace new challenges and to continue to improve the service. An increase in the provider’s oversight meant that a significant number of improvements had been made to help ensure that people were safe and received good quality care.
Improvements had been made to help ensure people were protected from the risk of poor management of medicines. The manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these. People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.
Staff had the knowledge and skills they needed to carry out their roles effectively. They felt supported by the manager and deputy at all times. The manager and deputy had a good understanding of the Mental Capacity Act 2005 (MCA). The care staff understood its principles and the importance of supporting people to make decisions and protect their rights. People enjoyed a healthy balanced diet based on personal preferences. Systems had improved to ensure food and fluid intake was monitored and recorded effectively.
People and their relatives felt staff were caring and kind. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. Care plans had improved and demonstrated that people were involved about how they wished to be supported. The manager, deputy and staff were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.
People benefitted from a service that was well led. People who used the service felt able to make requests and express their opinions and views. Staff were embracing new initiatives with the support of the manager and provider. They continued to look at the needs of people who used the service and ways to improve these so that people felt able to make positive changes.
The provider and manager had implemented a programme of improvement that was being well managed. The manager and provider demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service.