Below is a summary of what we found at this inspection. The summary is based on our observations during the inspection, speaking with eight people using the service and a visiting relative and health professionals. We also spoke with three care staff, the manager, and cook. We looked at four people's care records as well as other records related to the running of the service.Is the service safe?
People's consent was sought by staff before they provided care. One person who used the service said, 'Staff spoke with me about care arrangements and got my consent, I'm happy with these arrangements'.
Systems were in place to make sure that the staff learnt from events such as accidents and incidents to reduce the risks to people. For example we saw that accidents, incidents and falls were reviewed to identify any patterns or trends. This helps to manage potential risks to people's care and safety.
We saw that risk management plans were up-to-date and staff said they received updates when people's needs changed. We saw for example people had short term plans in place when receiving medical treatment. This ensured that people were not put at unnecessary risk.
We saw that staff had been provided with guidance in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to people who lack capacity, and how decisions should be made in their best interests when they do so. At the time of our inspection no applications had needed to be made. We found that people's mental capacity was assessed and included in their care plan. This meant that staff had access to information about people's ability to make daily decisions. Staff we spoke with told us where people lacked capacity to give their consent verbally they would use their knowledge of the people or speak to people's relatives in deciding what was in the best interests of people. We saw staff demonstrated their understanding of people's behaviour when they patiently explained options to a person and gained their understanding and consent.
Is the service effective?
People told us they had been involved in making decisions about their care. Care plans showed that the service was effectively responding to people's needs. For example we saw short term plans for people's immediate health needs. We saw that specialist dietary needs had been identified where required.
We saw the service cooperated with others such as visiting health professionals. This meant that staff took into consideration external professional advice in order to promote people's health and wellbeing with regard to the risk of pressure sores. We saw people had the correct equipment to meet their health care needs. A visiting health professional told us that staff were effectively monitoring and acting on any concerns regarding people at risk of developing pressure sores.
People had access to a range of health care professionals. One person told us, 'I had a fall and they [care staff] came straight away. They have discussed the risks with me and my family and we are happy with the arrangements'.
We saw staff supporting people at risk of not eating enough. People who used the service told us the food was good. We saw that care plans provided staff with some guidance on people's dietary needs. The cook provided meals suited to people who required a soft diet or specialist needs such as diabetic diet. However it was not always clear that people had an informed choice of the meal available. Training in relation to nutrition awareness had not been completed by staff to help them understand the importance of good nutrition. The cook had not undertaken training in nutrition awareness, and did not show sufficient knowledge about how to fortify people's meals.
Is the service caring?
We saw that staff interacted with people in a caring way. People we spoke with were complimentary about the standard of the care they received. One person told us, "There are very good staff here. I have the doctor if I need to, I have a daily newspaper, and my own privacy, I'm quite happy.'
We heard staff refer to people in a way that was not caring and did not up hold the dignity of the people living there. During the mealtime preparation we regularly heard staff refer to people as 'feeders', when discussing the needs of people who required support to eat their meals. This showed a lack of respect and did not demonstrate people's dignity was upheld.
Is the service responsive?
We saw that care plans were up-to-date and staff said they received updates when people's needs changed. We saw for example people had short term plans in place when receiving medical treatment. This ensured that people were not put at unnecessary risk and an interim care plan was put in place in response to their changed needs.
We saw that the activities available to people could be improved. We saw three people watched a DVD in the morning and then in the afternoon which they enjoyed but the majority of people had no activity to engage in. There were long periods in the day with no contact from staff or activity to promote their well-being. People spent large periods of time sleeping or dozing. When people were awake they were observed to fidget with their clothes or show other restless behaviour. We saw that staff engaged with people who had dementia mainly at times when tasks were carried out such as assisting them to move or assisting them to the toilet. Whilst this is responsive to their immediate physical needs there was little recognition of their emotional need for stimulation and contact.
Is the service well-led?
The service worked well with other professionals to ensure people received care and treatment appropriate to their needs. There had been a decrease in people experiencing pressure sores. We saw staff had received guidance to monitor this area of their practice. Visiting health professionals were satisfied staff followed guidance.
People we spoke with were not always aware of the provider's complaints procedure. Although this was available some people required assistance to promote their understanding. People said they would report any concerns they had to staff.
The provider had a quality assurance system which sought people's views via surveys. We saw the provider had acted on people's comments by making improvements within the service.
The availability of activities suited to people who experienced dementia required consideration. Appropriate stimulation was not always available so that people received a good quality service at all times.
Staff told us that they had one to one supervision but there was an absence of written records showing how their performance was monitored. The frequency of supervision needed to improve so that staff had regular opportunities to discuss and reflect on their performance.
The recent vacancy of a deputy manager was impacting on the managers' capacity to fulfil both management and care roles as identified in the supervision of care staff and records to demonstrate this. There was no computer or broadband in the service. This impacted upon the manager's ability to access current good practice guidance. There was no evidence that the provider had taken into account the support needs of the manager or the tools required to manage the service more effectively.