The registered manager named above no longer works at the home. They had not applied to cancel their registration at the time of our visit, so their name still appears above. A new manager had been appointed, but we had not received their registered manager application at the time of our visit. Twenty people were living at the home when we visited on 30 April. The home manager was not on duty on the day we visited, but we spoke with them the following day by telephone. We spoke with the duty team leader, two staff and seven people who lived at the home. People who lived at the home were not able explain the details of their care and support needs because of their complex diagnoses. However, we looked at people's care plans and observed how people were cared for.
We looked at five outcomes to answer the following questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?
Below is a summary of what we found. If you would like to see the evidence supporting our summary please read the full report.
Is the service safe?
People's needs and abilities were assessed before they moved into the home and care plans were written to make sure people's needs were met. The manager identified risks to people's care and welfare and took action to minimise the risks. A member of care staff told us they knew what to do because, 'I read the care plan when a new person moves in.' Staff kept detailed records about whether people ate and drank well which meant changes in people's needs were recognised promptly.
We found people received their prescribed medicines when they needed them. Staff made all the necessary arrangements to ensure medicines were obtained, managed, administered and disposed of safely. A member of care staff told us, 'People's medicines are reviewed regularly. The review date is shown on the prescription.'
Staff personnel records contained all the information required by the Health and Social Care Act 2008. The provider checked staff were suitable to work with vulnerable people and ensured they had appropriate skills and experience to support people who lived at the home. A team leader told us, 'New staff have to shadow experienced staff and have to complete a workbook' before they would be assessed as competent to work independently.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The duty team leader told us that they had not needed to apply to deprive anyone of their liberty. Staff were trained to use distraction techniques to help people avoid harm. No Deprivation of Liberty applications had been needed.
Is the service effective?
Records showed that staff asked other health professionals for advice according to people's needs. Staff told us that people's doctors responded promptly when they needed their advice. Staff ensured people had appropriate access to doctors, dentists and chiropodists.
Staff attended mandatory training and specialist training that was appropriate to meet people's needs. We saw the manager kept a list of when staff attended training, to ensure they attended refresher training promptly. The manager ensured new staff were supported to work towards obtaining nationally recognised vocational qualifications.
Is the service caring?
In the care plans we looked at, we saw people's likes, dislikes and preferences included life enhancing details, such as, 'Likes to wear watch, jewellery and perfume' and 'Likes physical touch and cuddles.' We observed staff knew these preferences and responded accordingly. We heard one person say to a member of care staff, 'This is a good place isn't it?'
Care workers encouraged people to be as independent as possible. For example, we saw staff respected one person's decision when they changed their mind about a decision they had made earlier in the day.
We saw a poster advertising various family events on the front door. People told us, 'It is nice here', 'I am growing vegetables' and 'We are having a garden party.' Relatives we spoke with told us they could visit any time. One relative told us, 'It is working very well.' We saw one family group brought cakes and made tea for themselves, which showed they felt at home.
Is the service responsive?
The manager regularly reviewed people's care plans and updated them when people's needs changed. Care staff we spoke with knew and understood the signs they should look for that might indicate the person's needs had changed. They understood the triggers for changes in people's appetite or behaviour.
Care staff told us that one person had woken late and had eaten their breakfast later than their usual time. We observed that staff understood the person would not be hungry again by lunch time. We saw staff assisting this person to eat a meal early in the afternoon instead.
Is the service well-led?
We found the service had an effective quality assurance system in place. The provider and manager carried out a regular programme of audits and checks to make sure the quality of the service was maintained. The results of their checks were discussed at regular staff meetings. This meant everyone knew the actions they needed to take improve the quality of the service provided.
Staff we spoke understood their own responsibilities for checking that the premises and equipment were clean and in good working order.
The manager analysed accidents and incidents to check for patterns or trends. This enabled them to take action to minimise the risk of re-occurrence. There were no identifiable patterns in the three months preceding our inspection.
People and their relatives were encouraged to give feedback about the quality of the service. A copy of the complaints policy was on display in the hallway and the provider regularly sent out questionnaires to find out what people thought. Care staff told us they planned to start monthly resident and family meetings again, as they thought some people might be more relaxed about making their views known in an informal environment.