Archived: The Island Residential Home

Updated 15 October 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was carried out on 13 August 2015. Our inspection was unannounced. This was a focused inspection to follow up on actions we had asked the provider to take to improve the service people received.

The inspection team included two inspectors. The team also included an expert-by-experience who had personal experience of caring for older people. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We gathered and reviewed information about the service before the inspection including information from the local authority, the provider’s action plan and our last report.

During our inspection we observed care in communal areas. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We examined records including staff rotas; management records, care records for six people and six staff files. We looked around the premises and spoke with 23 people, seven staff, the registered manager (who had stepped down to become the deputy manager) and the providers. We also spoke with seven relatives and one visitor. We spoke with the new manager by telephone after the inspection as they were on holiday during our inspection.

We asked the provider and registered manager to send us information after the inspection. We asked for some of the policies and procedures and the activities schedule. These were received within the timescales that had been set and agreed.

Updated 15 October 2015

The inspection was carried out on 13 August 2015. Our inspection was unannounced. This was a focussed inspection to follow up on actions we had asked the provider to take to improve the service people received.

The Island Residential Home is a privately owned care home that provides accommodation and personal care for up to 44 people. There were 32 people living at the home on the day of our inspection. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Accommodation is arranged over two floors. There is a passenger lift for access between floors.

The registered manager had stepped down from directly managing the service in 2015. A new manager had been employed. The new manager was in the process of applying to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the home is run.

At our previous inspection on 10 February 2015 we found breaches of seven regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. We took enforcement action and required the provider to make improvements. We issued four warning notices in relation to the safety and suitability of the premises, management of medicines, recruitment records and quality assurance and told the provider to comply with the regulations by 31 March 2015. We found three further breaches of regulations. We asked the provider to take action in relation to person centred care, staffing levels and nutrition and hydration.

The provider sent us an action plan on 30 May 2015 which stated that they would comply with the regulations by the end of June 2015 for six regulations and by September 2015 for Regulation 17 (Good Governance).

At this inspection we found that improvements had been made. The provider had met the requirements of the warning notices we issued at out last inspection. However we found some breaches of regulations relating to the fundamental standards of care.

The provider had failed to carry out checks to explore gaps in one member of staffs employment history. The provider had carried out necessary employment checks to ensure staff were suitable to work with people.

Medicines were stored, administered and disposed of safely. People received the medicines they needed when they needed them. However, there was no signature list to identify which members of staff had been trained to administer medicines. We made a recommendation about this.

Audits and systems to monitor the homes were still being developed. Some audits had taken place. The audit of staffing records had failed to identify that the employment history was not complete for one staff member; we found that 35 years of employment history was missing. We made a recommendation about this.

The provider failed to display their inspection rating following their CQC inspection in February 2015 and the publication of their report in May 2015.

Staff knew and understood how to protect people from abuse and harm and keep them as safe as possible. The home had a safeguarding policy in place which listed staff’s roles and responsibilities to keep people safe from abuse.

People were protected from harm because their safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified, such as falls, mobility and skin integrity.

The home had undergone a number of repairs and alterations. For example, new windows had been fitted, the gardens had been cleared, uneven paving had been corrected to prevent accidents, and a new fire escape had been fitted. A program of improvements had been developed which meant that improvements would be continuing over the coming year.

People told us that they did not have to wait for their care needs to be met. For example, call bells were answered promptly. There were enough staff on duty to meet people’s needs. Staffing numbers had increased to meet people’s assessed and changing needs.

Staff had undertaken training relevant to their roles. They said that they received good levels of hands on support from the management team to enable them to provide the care people needed.

There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005and Deprivation of Liberty Safeguards (DoLS) so that they understood how to protect people’s human and legal rights.

People had choices of food at each meal time. People were offered more food if they wanted it and people who did not want to eat what had been cooked were offered alternatives. People with specialist diets had been catered for.

People received medical assistance from healthcare professionals when they needed it.

People told us they found the staff caring, and that they liked living at The Island Residential home.

Staff were careful to protect people’s privacy and dignity and people told us they were treated with dignity and respect, for example staff made sure that doors were closed when personal care was given.

People and their relatives and visitors had access to communal areas, gardens and people were able to spend private time together. People’s information was treated confidentially. Personal records were stored securely to protect people’s privacy.

People told us that the home was responsive and when they asked for something this was provided.

Care plans included information on; personal care needs medicines, leisure activities, nutritional needs, as well as people's preferences in regards to their care. This meant staff had the guidance they needed to provide appropriate care and support for people.

People told us activities had improved. People were engaged with activities when they wanted to be. The manager and activities staff were developing a new activities schedule.

People knew who to talk to if they had a complaint. The complaints policy was displayed on the wall of the home. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales for a response.

Completed satisfaction surveys showed that there were high satisfaction levels amongst people and their relatives, particularly in the area of quality of care and staff attitudes. Relatives told us that they were kept well informed by the home and they were able to attend regular meetings and were able to speak with the manager and provider when they needed to.

People told us they were happy with the changes the provider had made to the home.

Staff were well supported by the management team. The provider and management team were visible throughout the home. Staff told us that they felt confident to contact the management team and were confident that they would gain support.

The new manager was aware of their responsibilities. They had developed links with external organisations to improve information sharing and good practice so that people received a good service.

You can see what action we told the provider to take at the back of the full version of the report.