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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Care plans did not always hold a record of people’s life history or personal preferences to guide staff on how to care for people in a person-centred way. Activities were not always taking place and staff told us they did not always have time to undertake meaningful activity with people. Not all staff felt supported at work and felt they did not always have enough time to spend with people. We did observe staff to be kind and treated people with dignity during interactions.

This service scored 35 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt staff treated them well. One person said, “The staff have been very respectful, I haven’t felt uncomfortable with them.” Relatives told us staff knew their loved ones well. One relative said, “The staff know [person using the service] and their ways.” While people we spoke to had no concerns in this area, our assessment found elements of care did not meet the expected standards as 2 people were sharing a bedroom without the appropriate consent in place and a lack of staff presence in communal areas meant people’s needs may not always be attended to in a timely manner.

Staff told us the importance of listening to people. One staff member said, “People like to feel valued and important. It is the little interactions that are important.” However, most of the staff we spoke to felt there was not enough time to meaningfully spend with people.

Partners did not offer any feedback in this area.

During our inspection, we observed staff to be kind and treated people with dignity. There was not always staff present in communal areas, however, when there was, we witnessed them to be polite and engaged with people well.

People felt they were treated as individuals. One person said of the staff, “They are as kind as they can be. When they have a job to do, they do it. I think they have gotten to know me.” Another person praised the staff for knowing them well whist not intruding on their personal life.

Not all staff had good knowledge of people’s cultural and social needs and offered little feedback in this area; however, one staff member spoke about reciting the Lord’s prayer with one person and expressed how this was a positive interaction.

Where staff had time to interact with people, their interactions were positive. However, people were left for long periods of time without any interactions from staff.

Care records held limited information on people’s communication needs. Records were very basic in this area and did not offer any prompts to staff about how best to communicate with people. Whilst some people had a life history section as part of their care plan, others did not which meant there was no record of their cultural or religious beliefs or of what they like to do. We were not assured staff could be guided by people’s care records.

People told us they felt bored in their environment due to a lack of meaningful activity. One person said, “It’s very rare we have activities. There’s nothing on a regular basis. I get a bit fed up.” Another person also commented that there was no stimulation. Relatives also felt improvements were needed in this area. One relative said, “Most of the time people are just sat around communally in the lounge, just watching TV, dosing or talking.”

Staff felt there was not enough stimulation provided. One staff member said, “There isn’t an activities coordinator, so, as we can be short staffed, activities don’t always happen.” Staff told us they promote independence by encouraging people to do things for themselves.

We saw very limited activities taking place. During most observations, people were sat sleeping in chairs. The TV was on, but no-one was engaging with this. The activity we did witness was positive and people appeared to be engaged and enjoying themselves

The process for activities was not robust. Not everyone had a documented account of their preferred activities, likes or dislikes and there were no designated activity staff. Care staff were relied upon to undertake activities when quite often they were busy with other tasks. The activity logs evidenced a lack of activities taking place and a lot of activities were ‘nail care’ or ‘hairdresser’ when these are more of a personal care intervention rather that a meaningful activity. Care plans did not outline what people could do for themselves or how staff could support people in being more independent.

People told us they did not always feel staff responded to them in a timely manner. Concerns were raised over nurse call bells and staff response to this. One person said, “I am not sure my call bell is working as nobody came this morning when I used it.” A relative also raised concerns in this area and responses to nurse call bell times varied.

The manager told us the maintenance staff do not test nurse call bells to ensure they’re working correctly and that this is the responsibility of care staff to test. However, the records evidenced gaps in this testing, meaning people could have a nurse call bell which did not work. Staff told us they felt people’s needs were responded to. Staff spoke of one person’s communication needs and how they use alternative methods to communicate with them.

During our walk arounds, it was apparent staff did not have the time to sit and talk to people. We noticed several incidents where a person needed assistance and there were no staff available to provide this. On day 1 of the inspection the lift was broken and there were no additional measures in place to alert staff a person should require assistance, despite being isolated in their bedrooms.

Feedback from staff was mixed in this area. Some staff told us they did not feel supported by the management team and found the workload stressful at times when there was not enough staff. Another staff member described the atmosphere as negative at times. However, some staff felt supported by the directors who were encouraging them to take a promotion and provided career progression opportunities.

Processes in this area were not robust enough. The training matrix identified several gaps in staff knowledge and no practical courses were available for staff to attend. Staff meeting minutes evidenced a negative culture between management and staff which would suggest staff were not able to speak freely. Supervisions were an observation and not a formal meeting which would give staff the opportunity to discuss their thoughts and feelings. The night on-call system was not clear and there was no formal guidance, policy or incentive for staff to take on this role.