9, 12, 15, 22 September 2014
During a routine inspection
We visited five households, communicated with 13 people who used the service as well as conducting a short observational framework for inspection observation. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We reviewed seven peoples care files and eight staff files. We also spoke with four people's relatives and reviewed information given to us by the provider.
Three inspectors and an expert by experience carried out this inspection. An expert by experience is a person who has first-hand experiences of the services we regulate. We considered our inspection findings to answer the questions we always ask: Is the service Safe, Effective, Caring, Responsive and Well led.
This is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
We found the service was not always safe because the provider did not have appropriate arrangements in place to manage medicines. This meant people were not always protected against the risks associated with medicines.
Is the service effective?
The service was effective. People benefited because the service understood the importance of maintaining links with family and friends for their well-being.
People expressed their views and were involved in making decisions about their care and treatment. There were clear records in people's files regarding the support they needed to make decisions. A communication chart was in place to ensure staff could recognise behaviours that may identify a choice.
The provider had worked continuously to maintain and improve high standards of care by creating an environment where clinical excellence could do well. We saw that when staff performance needed to improve the manager acted and performance was managed effectively.
Is the service caring?
The service was caring. People were supported in promoting their independence and community involvement. We saw one person wanted to learn to drive and they had been supported by staff who looked at positive risk and affordability. Positive risk is a process that involves weighing up the potential benefits and harm of exercising ones choice of action over another, identifying the potential risks involved, and developing plans and actions that reflect the positive potential and stated priorities of the service user.
We observed a number of warm and caring interactions between staff and the people they supported. Relatives we spoke with felt their relatives were well cared for. One relative told us, 'the staff are great, very caring; they are full of encouragement for people to do their best'. Another relative told us, 'the level of care is very reassuring to families who can no longer do it themselves'.
Is the service responsive?
We found the service was responsive as people's needs were responded to. We looked at six people's files and saw that each file contained an assessment that had been used to create support plans. These support plans had risk assessments to provide further guidance where appropriate. For example, one person required support with their mobility. We saw clear written guidance with pictures to show staff how to move this person safely and comfortably.
The provider took account of complaints and comments. We examined the provider's compliments and complaints file. We saw that complaints were recorded and responded to in a timely and appropriate manner.
Is the service well-led?
The service was well led. The provider had an effective system to regularly assess and monitor the quality of service that people received. During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the service was monitored on a consistent basis to ensure that people experienced safe and appropriate support, care and treatment.