During our inspection we looked in detail at how care was provided to the people who lived at The Holt Retirement Home. As the service specialises in supporting people living with dementia we used methodology that is currently in place to undertake themed inspections. The themed inspection programme focused on the quality of care provided to support people living with dementia to maintain their physical and mental health and wellbeing. The programme looked at how providers worked together to provide care and at people's experiences of moving between care homes and hospital. This allowed us to look at the specific needs of people living with dementia and to consider how these were being met at the service. During our visit we observed people's care and the regime and routines of the service. We spoke with people who used the service, a healthcare professional and a social care professional who were available. We asked members of staff for their views and spoke with a relative who was visiting.
We discussed the inspection and our findings with the registered manager who also acted as the nominated individual for the service provider CCHM Limited. We also left comments cards so people could share their views with us after our visit.
We observed that staff did not engage positively with the people in their care or provide any meaningful activity. We saw that staff were kept very busy and had little opportunity in which they could spend time with people. This was confirmed by staff members we spoke with and from comment cards submitted as part of the dementia themed inspection.
We found that care records including care plans and risk assessments were not up to date. Staff told us that they were not aware of what was in people's care plans and did not have time to look at them. This placed people at potential risk of receiving unsafe or inappropriate care.
Assessments completed by the service provider did not include sufficient detail to identify if the service could meet people's needs. Staff had not received training in dementia to enable them to provide safe and professional care.
We found that staff were not responsive to changes in people's needs. This meant that people were not always supported to obtain the appropriate health and social care support they needed. We observed, for example that one person had difficulty in drinking independently. We saw that a social care professional had to intervene to make sure this person received the right care at the right time.
We identified that staff had failed to seek appropriate treatment following falls and incidents that had resulted in serious injury. This meant that people had been placed at potential risk of harm.
During our visit we saw one member of staff dispensing medicine from the controlled medicine cabinet. This raised some concerns. We therefore extended our inspection to look at the management of medicines in the home. We found that medicines were not always being accurately recorded or monitored. We found that people including one person who had sustained a fracture had not been appropriately assessed for pain. Records did not provide staff with sufficient information about medication that needed to be administered on an 'as required' basis.
Staff including senior staff showed little understanding of good practice guidance in relation to dementia care needs. We found that people were not cared for in an environment that was made safer and more accessible to people with dementia.
The provider was not carrying out relevant checks when they employed staff. This meant that people could not be assured that the staff were qualified and suitable to be able to work with vulnerable adults.
Effective management arrangements were not in place to enable the quality of care to be assessed, monitored and improved.
Because of serious concerns about people's safety and welfare we made a further visit to the service on 13 February 2014 when similar issues and concerns were found. This is being followed up and we will report on any action when it is complete.