The week before we inspected the new manager contacted us to say that an employee had raised concerns about the practices at the home. The new manager had also alerted the local authority and safeguarding team about the concerns. To determine whether the issues raised were adversely affecting the service we completed an unannounced inspection. During the inspection we spoke to eight people who used the service and some people were able to make specific comments about the service. People said 'It's alright here'', ''I like the girls'' and ''The staff are kind''.Most people who lived at the home had marked problems with their memory and found it difficult to think about recent events or at times to have a conversation. Therefore we used a specific way of observing care to help to understand their experience of the service. This involved spending a substantial part of the visit observing a group of people to see how they occupied their time; appeared to feel; and how staff engaged with them. From our observation we saw that care staff did attempt to work in ways that supported the people, but lacked direction or someone to use as a role model. Thus, although we witnessed no overtly poor practice staff would at times use quite a sharp tone; did tend not to involve people in discussions about what was about to happen; did not engage with people who were quiet or had an abrupt manner; and did not display many of the expected good practices when working with people who experienced problems with their memory.
The nursing staff tended to spend a large part of the day in the office, but we did notice that the newest member of the nursing team was trying to ensure people experienced a good level of care. We observed that when people were experiencing distress, staff misinterpreted this as them ''singing'' or trying to express an opinion. One person we observed did not appear well, although care staff noticed this and quickly sought advice from the nurse in charge. The nurse was very dismissive of the individual's needs. We saw they completed a superficial check of the person's health, told staff to keep an eye on the person, but never returned to see if the person remained unwell. Neither did it appear that they had alerted the other nurse to the fact that the person was not well. We discussed the incident with the manager at the time of our inspection who ensured that this person's health was checked and they were not in need of medical attention. We also observed the nurse attempt to take blood from someone in the main corridor. It was clear this person strongly objected to this procedure being completed, but rather than stop, go back at a later date or contact the GP for their advice, they continued to try to obtain a blood sample.
We did observe that some of the staff engaged well with the people who used the service and that the activities coordinator worked effectively with people. She ran some interesting activities and used a variety of techniques such as reminiscence; object identification and encouraging people to recall past events to ensure individuals experienced meaningful occupation. One nurse was seen to interact well with people, as were a couple of the care staff, and these people told us how they had been trying to develop their practices and follow dementia care guidance.
We observed the new manager take charge of the events within the home, so ensured the person in distress received appropriate medication and was referred to the GP; stopped the nurse taking blood from the person; and made sure that all the people were regularly checked to see that they were fine, including those who remained in their bedrooms.