This was an unannounced inspection, which was undertaken over the course of two days. A second inspector was part of the inspection team during the second day of the inspection. Time was spent speaking with people who live in the home, visitors, staff, and the manager. We also spent time looking at various records and touring the building. There were 12 people living in the home during our inspection.Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.
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;
' Is the service safe?
' Is the service caring?
' Is the service responsive?
' Is the service effective?
' Is the service well led?
This is a summary of what we found:
Is the service safe?
There were effective systems in place to reduce the risk and spread of infection. We spoke with two people and two visitors during our inspection who told us they thought the home was kept clean. One person said, "My room is cleaned for me". A visitor told us that their relatives' room was kept clean and tidy.
People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. One person had been prescribed a food supplement. However, when we looked at their medicine administration records (MAR), we found that for a period of three days the medicine had not been given. We discussed this with the registered manager, who told us that the prescription had been altered and there was a delay in the person receiving their prescription.
People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. We found no record that showed if a legionella test had been completed. There was no risk assessment in place. Legionella are water-borne bacteria that can cause serious illness. Health and safety regulations require persons responsible for premises to identify, assess, manage and prevent and control risks, and to keep the correct records. We discussed this with the registered manager, who told us that they would arrange for the test to take place.
Appropriate checks were not always undertaken before staff began work.
Is the service responsive?
Care was not always planned to meet people's needs. Where a need was identified, a plan was not always in place to meet this need. One person was identified as being at high risk of skin breakdown. We saw that their care plan did not consider sufficient actions that staff should take to protect this person from skin breakdown. For example, there was no consideration of pressure relieving equipment on the person's bed, nor whether staff were required to assist the person to change position regularly to relieve the pressure on their skin.
Is the service caring?
During the both days of our inspection, we spent time talking with and observing people in various parts of the home. There was a relaxed atmosphere throughout the home. We saw that a number of people received visits from family members and friends. Some people chose to spend their time outside in the garden enjoying the sunshine, other people spent time in the lounge or their bedrooms. During both days of our inspection we saw that people living in the home were participating in various activities, such as ball games, watching the TV, and board games.
We spoke with two people who were living in the home. They told us they felt well cared for and that the staff were always there for them if they needed support. Throughout the inspection we observed that staff were kind and caring and in some instances were able to anticipate people's needs. People's privacy, dignity and preferences were respected.
Is the service effective?
Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. We found that where people had cognitive impairments associated with dementia, mental capacity assessments had not always been completed. We looked at the care plans for five people with dementia and found that mental capacity assessments and best interest decisions were not always recorded. For one of these people, we saw that their relative had signed to consent to the care and treatment provided. There were no records to show whether the person had appropriate legal authority to consent to the care and treatment for this person.
People's personal records including medical records were not always accurate and fit for purpose. We looked at the care plans and associated records for five people during this inspection. All of the files contained inaccuracies, inconsistencies and omissions.
Is the service well led?
The provider had some systems for reviewing and monitoring the quality of service provided to people, but these had not been implemented effectively to ensure that people were not at risk of unsafe or inappropriate care. We found that between 15 November 2013 and 07 June 2014, there had been six occasions where people had left the home without staff support, or staff being aware of their actions. We noted that one person had left the home on three times and on one occasion had been found by police after falling and was subsequently admitted to hospital. There were no records that showed any investigation or learning from each of these incidents to prevent reoccurrence. The provider had not notified CQC of the police incident in accordance with regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Following our inspection we raised a safeguarding alert with the local authority safeguarding team for further investigation under the safeguarding procedures.