Archived: Kings Ripton Road

We considered our inspections findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We talked with people who used the service. Not everyone we spoke with was able to communicate verbally with us. We used staff and people's communication records to assist us. All of these people communicated or indicated that they were well cared for and that care staff always treated them with dignity and respect. We saw from the plans of care we looked at that people were involved as far as practicable in developing their care and support needs and how these were met. Reviews of people's plans had been completed regularly and ensured that people were only provided with care based upon their most up to date care information. The majority of people we spoke with communicated or indicated to us that they had a positive experience of using the service.

Is the service responsive?

We saw that following an assessment of people's needs, their care plans were reviewed with the person and that changers were made to reflect accurately what the person's needs were and how staff reliably met these. This ensured that people were provided with person centred care and support. People had made and were supported with their choices on things such as the preferred gender of their carer, the time they wanted to do their social and other planned activities. People were referred to their health care support professionals such as their GP, speech and language therapist or for regular health check-ups where the person required this. Staff shift rosters and other records we looked at demonstrated to us that a sufficient number of staff with appropriate qualifications were available to meet people's needs reliably and consistently.

Is the service safe?

We saw that regular reviews of people's assessed health risks, such as the use of bed rails, choking, vulnerability and safe travel and transport had been completed. Checks completed by the provider and other external regulatory inspections such as those for legionella, gas, electricity systems and water safety checks had been completed to ensure that the premises were safe for people who used the service, staff and other visitors. Action had been taken following accidents and incidents to ensure that the potential for any recurrence was eliminated or significantly reduced. CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that there were proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. People were supported with an independent mental capacity advocate. This was to ensure that people were not deprived of their liberty. Relevant staff had been trained on the implications of the Mental Capacity Act 2005 DoLS.

Is the service effective?

Staff we spoke with during our inspection were all able to accurately describe each person's care and support needs and each person's independence skills. Our observations of staff supporting people confirmed to us that people had a good experience of using the service. Quality assurance reviews which had been completed by the provider had confirmed that the majority of people were satisfied with the quality of care they were provided with.

Is the service well led?

At our previous inspection we found that a temporary manager had been put in charge of the service. At this inspection of 15 April 2014 we saw that the temporary manager had remained at the service and was in the process of applying to become a registered manager. All of the staff we spoke with confirmed to us that if ever they had any concerns or something needed changing that the manager's door was 'always open.' Effective quality assurance systems were in place and concerns raised by people in an appropriate way were acted upon.

Although the home was still without a registered manager, we noted that a new permanent manager had been appointed and had already submitted her application to register with us. The interim management arrangements prior to her being appointed had proved effective in increasing support to staff and raising standards at the home. We also noted that seven new staff had been employed at the home, significantly reducing the number of agency staff being used to cover vacant shifts.

A GP who knew the service well told us, 'The service is not flagging up any major worries for us at the moment and staff have made stalwart efforts to improve things. Staff always seem to me to be incredibly caring'.

We found that there were enough staff to meet people's needs, that medication was managed safely and that systems to monitor the quality of the service had improved. However the lack of stable management at the home was something that concerned staff, visiting health and social care professionals, and also relatives. One relative told us, 'Management seems to come and go rather frequently and I've never understood why, I'm never told the reason why'

We consider that the provider had taken sufficient action to address known issues and identified concerns from our previous inspection and was now compliant in all outcomes we assessed. The provider must ensure that these improvements are sustained in the long run to ensure people's health and welfare needs are fully met.

We received mixed reviews from family member we spoke with about the quality of care received by their relative. One reported, "Staff do care and they know my (relative) well". However another family member felt that communication between the service and them had been very poor and concerns about thier relative's care remained unresolved.

Following our visit, we had considerable concerns that, for one person, there were serious shortfalls in their medication administration, and also in the monitoring and management of their continence. These concerns were being investigated by other safeguarding agencies and we await the outcome of their findings.