The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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. We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service, as well as to ensure premises were clean and well maintained. Staff were appropriately vetted via Disclosure and Barring Service and other checks, prior to employment. All areas of the building including people’s rooms, bathrooms and communal areas were clean, with infection control risks well managed and appropriately resourced.
The storage, administration and disposal of medicines was generally found to be safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). We found examples of good practice regarding the recording of medicine administration. We also found instances where medication audits had not successfully picked up on areas of inconsistency, particularly with regard to people’s ‘when required’ medicines and we highlighted this to the registered manager and director.
Risks to people were managed through risk assessments and associated care plans. These risks were reviewed regularly and incorporated advice from healthcare professionals to keep people safe.
Staff displayed a good knowledge of safeguarding principles and indicators of abuse. They were clear what to do should they have any concerns. People we spoke with, their relatives and healthcare professionals consistently told us the service maintained people’s safety.
Staff completed a range of training the registered provider considered mandatory, such as safeguarding, health and safety, moving and handling and dignity. Staff also completed training to equip them to support people’s specific needs, for example British Sign Language training. Staff displayed a good knowledge of the subjects they had received training in and had a good knowledge of people’s likes, dislikes and life histories.
Staff had built positive, trusting relationships with the people they cared for. Staff were well supported through regular supervision and appraisal processes as well as ad hoc support from management when required.
We saw people had choices at each meal as well as being offered alternatives. People spoke positively about the food they had and confirmed they could choose whether to eat with other people or in their room. We observed staff supporting people efficiently to eat and drink. We found the dining experience we observed to be functional but a missed opportunity to ensure people had a more positive, sociable experience.
The premises benefitted from some aspects of dementia-friendly design, although we found the ongoing refurbishment works had yet to have a significantly positive impact on people and, as yet, had not incorporated person-centred care into the design of communal areas. Person-centred care is about ensuring the person is at the centre of everything and their individual wishes and needs and choices are taken into account.
Likewise, whilst we found care planning documentation to be extensive, this did not always translate into person-centred care strategies, for example to distract and soothe people who may become anxious.
Group activities were varied and well planned, coordinated by a new member of staff with relevant experience. Improvements were planned to ensure people who could not choose to engage in group activities had alternative, meaningful options.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).
We checked whether the service was working within the principles of the MCA. The registered manager displayed a good understanding of capacity and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS. We found some care planning documentation referred to capacity in blanket terms rather than in terms of capacity specific to individual decisions. The registered manager and director agreed to review this.
People who used the service, relatives and external stakeholders agreed that staff were caring and compassionate. We saw numerous instances of warm, inclusive interactions.
Person-centred care plans were in place and daily notes were accurate and contemporaneous. We saw regular reviews took place, ensuring people who used the service, relatives and healthcare professionals were involved.
The service had built and maintained good community links. Staff, people who used the service, relatives and external professionals we spoke with knew the registered manager and were positive about their approachability, responsiveness and knowledge of people who used the service.