There were six people using the service which was registered for up to 20 adults over 65 years. This was the service's first inspection since the provider's registration in 2013. Our inspection was unannounced and because of concerns raised we responded to the concerns by bringing the inspection forward. The service was in a state of transition as it had removed nursing care from its provision on 13 June 2014. The registered manager was no longer employed by the provider. This meant the provider was in day to day charge of the service. The provider was also responsible for the daily meals of people who used the service. Staff told us being responsible for the shifts was a new challenge for them and they needed time to adjust to this. People using the service told us that they 'missed the nurses for advice', although the care staff were helpful to them. This meant there were levels of uncertainty for people using the service and staff about how the service was to be run.As part of our inspection we spoke with six people who used the service. We also spoke with two health care professionals, four members of staff and the provider who was managing the service daily with a senior care worker.
We considered all the evidence we gathered under the outcomes we inspected. We used the information we always ask;
Is the service safe?
We looked at the suitability of the environment to ensure people lived in a home where the d'cor and environmental standards were appropriate. We found the home was clean, safe and well maintained but there was a smell from the downstairs drains that lingered in the corridor. The provider told us he would attend to it.
All the necessary recruitment checks had been completed prior to staff commencing their employment at the home before the changes. Following the changes the recruitment practices in place were not as safe as new staff had not been through a thorough vetting process. This meant there was a potential risk to vulnerable adults of unsuitable staff working with them.
Medicines used at the home were stored and administered safely. On talking with staff they told us that they would benefit from further training information around the management of medicines. One person spoke about their medication they said 'They're very, very good with that'.
This meant people were appropriately supported and we found medications were administered and stored in a safe way. We found a small number of recording errors for when medicines were administered and for the return of some prescribed items. We bought these to the attention of the senior and provider for further investigation.
During the day time to ensure people were safe there was at least one member of staff in the lounge area.
One person told us 'Everyone tries to help you' and another person said 'Staff are around when you need them and this makes me feel safe'.
Another person told us there were 'Enough staff on duty when they needed them and if they ever had to wait for assistance the staff were always pleasant and helpful'. This meant people were supported by staff who could meet their needs.
The Mental Capacity Act 2005 (MCA) is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves. We were told by the provider there was no one who needed a Deprivation of Liberty Safeguard. This is where a person is restricted of their freedom and considerations are made in the person's best interest.
Is the service effective
Staff were not always supported to provide care to the people using the service. This was because they had not had sufficient time to prepare for the transition for being in charge of the shifts now that nurses were no longer employed at the service. The provider was also busy covering shifts in the kitchen whilst supporting senior care workers with the management of medications, should one of their experienced managers not be available at the home.
We found that less experienced care workers were not always being supervised by senior staff and we saw a staff member who applied a topical medicine for a person without wearing protective equipment for their hands. This meant the ability to monitor staff's performance was difficult to oversee on a regular basis and further development of the systems in place for staff support was needed.
Is the service caring?
We observed staff during the inspection. We saw staff had warm and friendly relationships with people using the service. We observed people's care and support during the visit and saw that they were well supported. People we spoke with told us they were satisfied with the care and support they received and we saw they were usually treated respectfully.
Is the service responsive?
During the inspection visit we spoke with a person who was receiving specific treatment. They told us staff gave them their medicines when they needed them and checked that they were not experiencing any problems by checking their treatment levels twice a day. People told us staff supported them when they needed their help. This included applying medicated creams when they were in discomfort.
People told us they had no cause to complain as their needs were being met by helpful supportive staff. A complaints procedure was available for people to use although we found that it may need to be placed in a number of prominent positions throughout the home due to the home's design and being built on three floors.
Is the service well led?
Not all quality monitoring systems were available for us to see during the inspection. The provider explained that they helped to monitor the medications with the senior care worker in charge. This was done by checking medicines were handled correctly and kept safely. People told us they were given their medicines when they needed them. Information to confirm the employer's liability insurance was up to date was sent to us as requested following our visit. Other information to confirm that servicing at the home took place and was up to date was also sent to us by the provider. The quality of the service that people received was managed in their best interests although the documentation for this was not always organised for the purposes of monitoring.
Below is a summary of what we found. To see the evidence supporting our summary please read the full report.