10 September 2014
During an inspection looking at part of the service
During the inspection we spoke with the acting manager and the provider and three other members of staff. We also spoke with four of the people who lived in the home.
We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We looked in detail at the care being delivered to five people who lived in the home. We found that actions stated in people's care plans as being required to care for and monitor their health were not being taken. For example one person at high risk of malnutrition was not being weighed at the intervals specified in their care plan. This meant their weight was not being monitored closely which increased the risk to their health and well-being. We had identified this issue at our previous inspection and had been told by the provider that the problems had been rectified but we could see that they had not.
Is the service effective?
Examination of care records showed that care plans had not always been updated to reflect people's current personal and healthcare needs. For example the care plan for one person regarding their mobility had been written in November 2013. The care plan had not been rewritten or updated to reflect significant changes in this person's needs. Without up to date and accurate care plans there was a considerable risk that staff would not have the information they require to deliver effective care, particularly as the home was mainly being staffed by agency nurses providing the nursing cover. These nurses were not employed by the home and would not have known the people who lived in the home as well as staff who were employed by the home.
Is the service caring?
During our inspection we saw care staff engage and interact positively with people who lived in the home. They appeared to know the people well and have good relationships with them. One care staff told us that they were disappointed that the home was closing. They felt that the care they provided was good but they were aware that there were a lot of problems. The nurse on duty during our inspection spent a considerable period of time ringing care agencies to find cover for the night shift for that night which took her time away from supporting the people in the home.
During our inspection we saw people who lived in the home were sitting for long periods with nothing to do. We saw that there was an activities worker present but they were spending the majority of their time in the conservatory writing records. In the afternoon we saw the activities worker play bingo with three of the people who lived in the home but we did not see any interaction or engagement with the nine other people in the home.
Is the service responsive?
The provider had told us that building plans and finances had been agreed in principle to re-build the conservatory. We went into the conservatory and could see that no changes had been made. The conservatory was very cold and there was condensation running down the windows. The day of the inspection was a warm day and as the day progressed the heat in the conservatory was very uncomfortable.
The provider told us that for a number of different reasons work on the conservatory had not been started. Planning permission had not been applied for and no changes had been made to the structure since our last inspection.
At our previous inspection we had raised concerns about the quality of the care plan audits. We had stated that they were not fit for purpose. We asked to see the care plan audits and we saw that none had been carried out following our previous inspection.
Is the service well led?
We spoke with three members of staff during our inspection, two of them were employed by the home and one member of staff came from an agency. All of the staff we spoke with told us that they had not received any formal supervision since they had been working at the home. We asked the acting manager about supervision and they confirmed that the majority of staff had not received any. They showed us a supervision planner which showed that four supervision sessions had taken place since our previous inspection in May 2014. We told the acting manager that this was inadequate and that staff were not being supported appropriately.
At our previous inspection we had raised concerns about the quality of the medication audits. We saw that the acting manager had tried to audit the medication processes. However we had concerns that these processes were inadequate as we were still able to identify a number of problems with the medication records. We were told that due to previous problems with the controlled drugs that these were audited daily. We looked at these records and saw that this audit had been missed five times in the previous 10 days.