15 December 2015
During a routine inspection
The inspection was unannounced and took place on 15 December 2015. The service is residential service for up 33 older people some of whom may have dementia type illnesses, 31 people were in residence on the day of inspection. People have their own bedrooms with ensuites and these are located over four floors accessed by a main shaft lift with some rooms accessed via stair lift for those who cannot manage stairs.
This service was last inspected on 15 January 2014 when we found the provider was meeting all the regulations.
There was 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.
People were treated with kindness and respect by staff. People told us they felt safe and liked the registered manager and staff that supported them. Relatives told us they had no concerns about the service and were satisfied with the overall standard of support provided. They felt confident in the quality of care and said they were kept fully informed by the service and that communication was good.
Medicines were managed well by trained staff but we have made a minor recommendation for improvement to the recording of administered creams in bedrooms. Staff had received fire training and understood fire procedures and the evacuation of the building, they attended fire drills. We have made a minor recommendation however, that the provider seek further advice from the fire service in regard to people's personal evacuation procedures.
There were enough staff with the right skills to support people properly. Recruitment processes ensured only suitable staff were employed. Staff received induction and a range of training to give them the knowledge and skills they needed. Staff felt listened to and supported staff received regular formal supervision and met regularly with their registered manager, records of these discussions were made available to view.
Staff were able to demonstrate they could recognise, respond and report concerns about potential abuse. The premises were clean, well maintained and undergoing a programme of upgrading to address identified shortfalls in the standard of accommodation in some areas. All necessary checks tests and routine servicing of equipment and installations were carried out.
People ate a varied diet that took account of their personal food preferences. Their health and wellbeing was monitored by staff that supported them to access regular health appointments when needed. People received information mostly in suitable formats and the registered manager was now looking at use of pictorial prompts for some people. People were supported to maintain their independence for as long as possible and at a pace to suit them.
Staff were guided in the support they gave to people through the development of individualised plans of care and support; risks were appropriately assessed to ensure measures implemented kept people safe. People were encouraged by staff to make everyday decisions for themselves, but staff understood and were working to the principles of the Mental Capacity Act 2005 (MCA) where people could not do so. The MCA provides a framework for acting and making decisions on behalf of people who lack mental capacity to make particular decisions for themselves.
People and relatives told us they found staff approachable and felt confident of raising concerns if they had them. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had referred a number of people for assessment for DoLS authorisations but these were still to be processed. The registered manager understood when an application should be made and the service was meeting the requirements of the Deprivation of Liberty Safeguards.
People said their needs were attended to by staff when and if they required it. People respected each other’s privacy. People were supported to maintain links with the important people in their lives and relatives told us they were always consulted and kept informed of important changes.
People and relatives were routinely asked to comment about the service and their views were analysed and action taken where improvements could be made. Quality assurance audits were undertaken, to monitor service quality and address any issues highlighted from these within set timescales.
We have made two recommendations:
We recommend that the registered manager review the recording of creams administered by staff and how omissions in administration are recorded in accordance with the providers medicine policy and good practice guidance in regard to managing medicines in care homes (published March 2014) NICE
We recommend that the provider consult the Fire Service regarding peoples personal evacuation plans to ensure these meet current fire legislation Regulatory Reform (Fire Safety) Order 2005.