Background to this inspection
Updated
4 September 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.
We undertook an unannounced inspection of this service on 20 and 21 May 2015. The inspection was undertaken by one inspector.
We focused on speaking with people who lived in the home, some of whom were able to tell us directly about their day to day experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with staff and visitors. During our inspection we spoke with nine people who live at the home, four visitors, four care staff, the deputy manager and the registered manager as well as a visiting social care professional. Following the inspection, we also sought the views of a health care professional about their views of the home.
We reviewed a range of records. This included four care plans and associated risk information and environmental risk information. We looked at recruitment information for four staff, including some who were more recently appointed; their training and supervision records in addition to the training record for the whole staff team. We viewed records of accidents/incidents, complaints information and records of some equipment, servicing information and maintenance records. We also viewed policies and procedures, medicine records and quality monitoring audits undertaken by the registered manager and management company.
Before the inspection we reviewed the information we held about the service. We considered information which had been shared with us by the local authority, members of the public, relatives and healthcare professionals. We reviewed notifications of incidents and safeguarding documentation that the provider had sent us since our last inspection. A notification is information about important events which the home is required to tell us about by law.
Our last inspection identified breaches of regulations. We looked at the action plan the provider had sent us following the last inspection. This set out how the home intended to make the improvements needed and when they would be completed. This formed part of our planning process for this inspection.
Updated
4 September 2015
The provider has been in receivership since January 2014 and the receivers have a management company acting as their agents and managing this service and others owned by the provider.
We undertook an unannounced inspection of this service on 20 and 21 May 2015. This service provides accommodation and personal care for up to 22 people. People at the home are older people with forms of dementia, some of whom have limited mobility. There were 19 people living at the home at the time of our inspection. Accommodation is arranged over two floors, most people had their own bedroom although one room was shared by two people. Access to the first floor is gained by a lift, making all areas of the home accessible to people.
This service had a registered manager in post. A registered manager is a person who is 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.
We last inspected the home in March 2014. We found the provider was in breach of regulations about the how they managed medicines and the training provided for staff. The management company sent us an action plan telling us what they intended to do to make the improvements needed. During this inspection we checked to see if the relevant regulations were met. We found our previous concerns had been addressed; however, we identified other areas that breached regulations.
People and their visitors commented positively about the care and support received and their experience at the home. However, the inspection highlighted shortfalls where the regulations were not met. We also identified areas where improvement was required and made recommendations that the home should adopt and put into practice published best practice guidance.
Assessed staffing levels did not ensure that were always sufficient staff to meet people’s needs without impacting on their choices about when they got up and went to bed. Staff told us at times their shifts felt difficult and hectic to ensure that people’s needs could be met. Some medicines were not correctly stored.
Authorisations made under the Mental Health Act 2005 to deprive people of their liberty were not notified to the Commission when they needed to be.
As a home specialising in the care of people experiencing dementia, we also recommended that they take note of and implement published best practices for adaptations to the home to enhance the safety and experience of people.
When some staff spoke to people, although well intentioned, they on occasion called people “darling” or “duck”. For people living with dementia, this practice did not always help people to recognise that staff were talking to them. Most activities tended to be group based and did not take place each day. There was no system to evaluate activities or people’s engagement levels in them. Although people and their relatives knew how to make a complaint, no complaints procedure was displayed. The home lacked a plan or strategy of continuous development to ensure that best care practices for a dementia setting were adopted and driven forward. These are areas we have identified for improvement.
The registered manager and deputy manager had a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards, they understood in what circumstances a person may need to be referred, and when there was a need for best interest meetings to take place. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and that people’s rights were respected and upheld.
The service records showed that there were low levels of incidents and accidents and these were managed appropriately by staff who sought appropriate action or intervention as needed to keep people safe. Risks were identified and strategies implemented to minimise the level of risk.
Care plans were reviewed regularly and included the views of the people and their relatives or advocates when needed. The home showed an awareness of people’s changing needs and sought professional guidance, which was put into practice.
People were able to choose their food at each meal time, snacks and drinks were always available. The food was home-cooked, including some home-made cakes. People told us they enjoyed their meals, describing them as “excellent” and “first class”.
Staff understood how to protect people from the risk of abuse and the action they needed to take to alert managers or other stakeholders if necessary if they suspected abuse to ensure people were safe.
Robust recruitment processes were in place. New staff underwent an induction programme and shadowed experienced staff, until they were competent to work on their own. There was a continuous staff training programme, which included courses relevant to the needs of people supported by the home. Most care staff had completed formal qualifications in health and social care or were in the process of studying for these.
The home was led by a registered manager who worked closely with the deputy manager and the staff team. Staff were fully informed about the ethos of the home and its vision and values. They recognised their own roles as important in the whole staff team and there was good team work throughout the inspection. Staff showed respect and valued one another as well as people living at the home.
We found four breaches in total. Three related to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as well as one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.