This inspection visit was unannounced and took place on 8 November 2016. At our last inspection visit on 8 December 2015 we asked the provider to make improvements across all aspects of the service we inspected. The provider sent us an action plan which explained the actions they would take to make improvements. At this inspection, we found improvements to some areas; however some aspects still required improvement. The service was registered to provide accommodation for up to 41 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 41 people were using the service.
There were two registered managers in post to support the running of the home. A registered manager is a person who has 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.
At our last inspection on 8 December 2015 compliance actions were issued in relation to staffing, medicine management, the need for consent and areas of good governance. The provider sent us an action plan in January 2016 explaining the actions they would take to improve. At this inspection, we found improvements had been made regarding consent and medicines management. Some improvements had been made in relation to staffing, however further consideration was needed to ensure consistency. We found insufficient improvements had been made in relation to the auditing of the service and recognising how to drive improvements.
The managers had not always understood the requirements of their registration. This resulted in us not receiving notifications about events at the home. Audits to monitor and evaluate the service were not always completed to reflect on quality and drive improvements. Information was not always clearly recorded to ensure people’s needs would be met.
Staff felt supported and there was a warm friendly atmosphere. We saw people were supported for their needs, however there was not always a consistent level of staff. People felt safe, but not all the staff were able to provide us with the assurance they understood how to protect people from harm and the reporting process. There were no evacuation plans to provide guidance if the home needed to be evacuated.
People were able to make their preferences know, which had been documented in the care records. People were encouraged to be independent and make choices about how they spent their day. There was a complaints procedure and people felt able to raise any concerns. People and relatives felt the environment was warm and friendly.
People had established relationships with staff and felt cared for. People told us staff treated them with dignity and respect. Relationships and friendship that were important to people were maintained. Support and compassion was provided when people neared the end of their life.
People’s capacity assessments had been completed and when required best interest decisions had been made with the relevant people to support. Some people were deprived of their liberty and the appropriate safeguards and authorisations had been sought from the local authority.
We saw people had a choice of food and were able to make decisions about the menu and the meal experience. When required support and advice around health and nutrition had been considered. Staff received training to enable them to support people and to support specific health needs. Support from health professionals was requested and available when needed.
Medicines were administered in line with people’s prescriptions and specific needs to support their health. Risk assessments had been completed and guidance provided. The provider ensured appropriate checks before people worked at the service.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.