The inspection took place on 17 April 2015 and was unannounced.
The service is a purpose-built home providing residential care for up to 35 older people, some of whom are living with dementia. There were 21 people living at the home at the time of our inspection. Accommodation is arranged in four units over two storeys. All bedrooms are for single occupancy and have en suite bathroom facilities.
There was no registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run. The service manager had been in post for three weeks at the time of our visit and had begun the process of registering as manager with the CQC.
People’s medicines were not always administered or recorded accurately. For example there was no record that one person had received their medicines on four occasions during one week in March 2015 and no record that another person had received their medicines on four occasions during one week in April 2015.
Some staff had not attended training in core areas as often as the provider’s training policy stated they should. For example fewer than half the staff employed had attended dementia awareness or end of life care training in the last two years and only one third of staff had attended infection control training in that period. Staff had not been appropriately supported through supervision and appraisal or had opportunities to discuss their professional development needs.
People’s needs had been assessed but had not been regularly reviewed, which meant that their care plans did not accurately reflect their needs or preferences about their care. The service manager told us that recent quality monitoring checks carried out by the provider had identified that people’s care plans did not reflect their needs as they had not been reviewed or updated for some time.
People told us that there were not enough opportunities to take part in activities or to go on trips out. They said they enjoyed the activities and outings that had been arranged but that they would like these to be organised more often.
People told us they felt safe at the service and that staff were available when they needed them.
Staff were aware of their responsibilities should they suspect abuse was taking place and knew how to report any concerns they had.
Risks to people had been assessed and control measures had been put in place to mitigate against these risks. There were plans in place to deal with foreseeable emergencies and to ensure that people’s care would not be interrupted in the event of an emergency. People were kept safe by the provider’s recruitment procedures.
The service manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), which meant that people’s care was provided in the least restrictive way. People told us that staff asked them for their consent when they were supporting them. They said staff encouraged them to make decisions and supported their choices.
People were supported to stay healthy and to obtain treatment when they needed it. People told us that they were able to see a doctor if they felt unwell and that staff supported them to attend medical appointments. People told us that they enjoyed the food provided by the service and that they could have alternatives to the menu if they wished. People’s nutritional needs were assessed and any dietary needs recorded in their care plans. Any specific dietary needs were communicated to kitchen staff by the care staff.
The service provided accessible, safe accommodation. The premises were suitably designed for their purpose and adaptations and specialist equipment were in place where needed to meet people’s mobility needs. The service manager told us that the service improvement plan included plans to make the environment more dementia-friendly for people living with this condition.
People told us that staff were kind and caring. They said they had good relationships with the staff and that staff treated them with respect. The atmosphere in the service was calm and relaxed and staff spoke to people in a respectful yet friendly manner. Staff understood the importance of maintaining confidentiality and of respecting people’s privacy and dignity.
People told us that they would feel comfortable making a complaint if they needed to and were confident that any concerns they raised would be dealt with appropriately. The complaints record demonstrated that any complaints received had been investigated and responded to appropriately. The service manager had improved the systems through which people could give their views about the service. Regular meetings had been introduced for people who used the service, relatives and staff at which they were encouraged to provide feedback about the service and suggest improvements.
There was no registered manager in place at the time of our inspection. The service manager had been in post for three weeks at the time of our visit. Whilst the service manager had made improvements since their arrival, leadership of the service had been inadequate until that point.
Staff told us that the service manager had improved the leadership and support they received.
They said the service manager was open and approachable and available for advice if needed. The service manager had improved the systems for quality monitoring and auditing. A service improvement plan had been developed following a recent clinical governance audit, which aimed to address the areas where improvements were needed.
During the inspection we identified some 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 the report.