Prior to our inspection we reviewed all the information we had received from the provider. We spoke with six people who used the service, and three relatives for their views and experiences. The registered manager was not present on the day of our inspection. We spoke with the nurse in charge, two nurses and two care workers. We looked at some of the records held in the service, including the care files for four people who used the service. We also used observation to understand people's experience, as some people had communication needs and were unable to tell us their views and experiences.
We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.
Is the service safe?
People told us that they felt safe. Relatives said they had no concerns about the safety of people and that people were cared for well.
We found some concerns with the staffs practice in relation to the administration of medication. We observed nursing staff did not stay with the person to check they had taken their medicines safely. The medicines trolley was not appropriately secured at all times.
We also found concerns with how people were supported with their mobility needs. We observed some poor moving and handling practice. This meant people were not always protected from risks due to unsafe practice.
The provider had safeguarding policies and procedures in place that protected people from abuse. We found staff were knowledgeable about their role and responsibility in ensuring people were safe.
The provider had increased staffing levels since our last inspection in November 2013. The staff rota was based on the care needs of people, and informed what the numbers, qualifications, skills and experience of staff were required.
We, the Care Quality Commission (CQC) monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to nursing homes. This means that when people have their liberty deprived in order to keep them safe, this was only done following a best interest assessment carried out by the local authority DoLS team. At the time of our visit there was nobody using the service who required a DoLS authorisation. We saw staff had received training on DoLS.
Is the service effective?
People had received a pre-assessment and care plans and risk assessments were reviewed monthly. We saw documentation that showed people that used the service, and their relative or representative had been involved in discussions and decisions about the care and treatment provided.
We saw the provider made appropriate referrals to health professionals when people's health condition or needs had changed.
The provider supported its staff by providing them with regular training, supervisions and competency assessments, to ensure staff developed their knowledge, experience and skills.
Is the service responsive?
The provider had a complaints policy and procedure that supported people to know their rights, and what action to take should they wish to complain about the service. However, the system used by the provider to record and respond to complaints was not clear. It was difficult to ascertain that complaints had been responded to in a timely manner and to a satisfactory conclusion.
The provider arranged 'resident' meetings to enable people who used the service an opportunity to share their views, and to be informed about the running of the service or changes that occurred.
An activity coordinator worked 25 hours a week and provided in-house activities and organised community trips.
Is the service caring?
On the whole people who used the service and relatives said staff were caring. Comments included, 'You know who you can go to, the manager is good, approachable and responds quickly to any issues.' And, 'The staff are caring, approachable and friendly.'
We saw examples that showed staff were caring and attentive but found some inconsistencies with staffs practice. We saw examples when staff did not always show care and compassion, for example when people refused their meal or became upset.
We found staff knowledgeable about people's needs, preferences and routines.
Is the service well-led?
Relatives and staff spoke highly of the manager and said they felt the service was well led and organised.
Staff were aware of their roles and responsibilities, this showed good leadership and accountability.
The provider had systems and processes in place to monitor the quality and effectiveness of the service it provided. However, we found some concerns with the audit system in place that checked records were completed accurately and appropriately.