The inspection took place from 14 July 2015 to 17 July. Further phone calls and contact were completed by 24 July 2015. This inspection was announced to ensure there was a senior staff member or the registered manager at the service when we visited.
The service is a residential care home for older people. It has twelve beds and currently supports ten people.
The service had a registered manager. 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 felt safe and well cared for and had their needs met. They felt part of the home and involved in the service provided. They enjoyed the homely and friendly atmosphere and shared positive comments about the service and most of the staff. One person told us that a staff member had, on one occasion, been discourteous and we fed this back to the registered manager. However, we were unable to explore this further.
People were comfortable and at ease in the presence of staff and there were opportunities during activities and meal times for people to engage with staff and others living at the home.
While there were sufficient staff to meet people’s needs, several people and staff felt that there was insufficient time to spend with people because of the wide scope of duties care staff were tasked with carrying out which included cleaning, quality checks, cooking and some catering.
Our observations showed that staff took an interest in each person and understood their specific needs and wishes, supporting them with a person centred approach. People spoke about the positive relationships and friendships they had made with others living at the home, including some of the staff.
People had care and support plans which took account of their level of independence and staff regularly discussed people’s needs with them to identify changes. We heard staff seek verbal consent before providing support and observed people being assisted to maintain their safety. Care plans showed that people had been consulted and where able, had signed their consent to decisions made within the plan.
While risks to people were reviewed it was not always clear how this process was carried out. There was limited information in some care plans regarding how risks were effectively reviewed and documented.
People received their medicines on time and the staff we spoke with understood how to administer medicines safely. They told us what actions they would take in the event of errors or omissions.
The service was not effective. While some training was made available to some staff and some development opportunities were provided, the approach was inconsistent. All new staff were given opportunities for shadowing more experienced members of staff. New staff that had social care experience was not always offered in-house training to develop their skills. Staff new to care work were provided with an induction and comprehensive training, yet existing staff did not have specific training to support their learning and development needs. Some staff had not received moving and handling or safeguarding adults training and most staff were not aware of the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards. There were inconsistencies in how staff received supervision and appraisal.
People had mental capacity to make decisions about their care and treatment and we were informed that no one living at the service was subject to a Deprivation of Liberty Safeguard. Where people do not have mental capacity to consent to their care or where their freedom of movement is restricted or they are subject to continuous supervision, decisions about some aspects of their care might have to be made within the framework of the Mental Capacity Act 2005 (MCA). We were told by the registered manager that no one living at the home lacked sufficient capacity or would require an MCA referral.
People enjoyed their meals and drinks and had sufficient amounts to eat. People were involved in growing food from the garden and this was used to make fresh and nutritious meals. People had a choice of soft drinks and alcoholic beverages with their main meal and could choose an alternative if they did not like the main meal of the day.
People were referred to healthcare professionals appropriately and in a timely way to ensure that changes to their health were monitored, treated and addressed. Staff worked with a variety of health professionals to implement care and treatment for each person.
People were cared for by staff that interacted in a caring and considerate manner. They provided meaningful and individualised care, demonstrating patience, understanding and an awareness of people’s needs when delivering care and support. Staff engaged responsively with people and enjoyed appropriate humour to add to the friendly and homely atmosphere. People were encouraged to express their comments and wishes about their care and treatment through open dialogue and informal discussions with the registered manager and staff. We heard discussions between staff and people about future health appointments and changes to their treatment. These discussion took place in private or quiet areas of the home.
People’s preferences were recorded in their care plans. There was guidance on how people wanted to maintain their own independence and have their aspirations valued and respected. This included how staff would meet the expressed needs of people who had limited vision and hearing.
People were encouraged to complete feedback surveys and share their experiences and comments about the service. People’s views were taken into account and used to improve the service. Feedback from relatives was positively received, addressed and used as an opportunity for learning, development and to improve people’s experience.
People were supported and encouraged to follow their own personal interests and to continue enjoying community activities and maintain their hobbies. These included poetry groups, gardening and visiting local shops and places of interest.
The service had an internal whistle-blowing policy and had recently updated several other policies. Medicine and fire checks were completed although general health, safety and maintenance checks were not evident or routinely carried out but there were safety and service-level contracts in place.
The registered manager was aware of the day to day culture within the service and fostered team values, communication and tailor-made care for people. Where staff fell short of delivering the service values these were challenged and addressed.
Staff expressed confidence in discussing matters of concern openly with the registered manager. People and relatives felt that the registered manager would address their concerns and was reliable in making the necessary changes when issues were identified. There was an open door policy for staff, people and relatives and this contributed to the transparent culture of the service.