A single inspector carried out this inspection. The focus of the inspection was to answer five key questions:Is the service Safe? Effective? Caring? Responsive? and Well-led?
Below is a summary of what we found. The summary describes what people using the service, visitors to the home and members of staff told us, what we observed and what we learnt from the records we looked at. We spoke with seven people who lived in the home, and with two care assistants, the deputy manager and the registered manager. Records we looked at included four care records, staff training records, management audits and the service's quality assurance documentation.
Is the service safe?
All staff were up to date with training about safeguarding vulnerable people. Staff we spoke with had a clear understanding of what constituted abuse and how to refer any concerns as safeguarding or whistle blowing issues.
Staffing of the home was organised such that people were seen regularly throughout the day. Their wellbeing was checked and recorded each time staff attended to them. Any concerns were reported promptly to more senior staff. Staff were directed to ensure people had call bells to hand, so they could summon assistance when they needed it.
The home had contingency plans for maintaining people's safety in the event of emergencies arising. We saw that call bells were answered swiftly in most cases, although we have highlighted to the provider that twice during our inspection this was not the case.
Is the service effective?
Care plans included a range of assessments which were reviewed monthly. This enabled changes to be made to people's planned care needs and identified risks were reviewed. Staff we spoke with said the care plans guided the care and support people received. They received a handover of updating information each time they started work. People's descriptions of support they received matched exactly with the care plans that we read.
Records showed staff noticed and recorded changes in people's health and wellbeing. Health professionals were contacted in a timely way, as necessary. Comprehensive planning and recording of wound care showed pressure area ulcers were treated effectively
Staff of the home received regular training to support them to care for the people who lived in the home. This included training about conditions such as Parkinson's disease and dementia. There was an organised system for all staff to receive individual supervision, which assisted them to make links between their training and practice. Care assistants were supported to achieve diploma qualifications and to identify external additional training to increase their effectiveness.
Is the service caring?
We observed attentive, meaningful and friendly interactions between staff and people in the home. Staff explained care intentions to people and allowed time for responses. Staff told us there were always enough staff to meet people's needs
People we spoke with said they got up at times that suited them and went to bed when they wanted to. We saw three people being supported to eat their lunch. The staff members were focused on the task, engaged in conversation as people wished and assisted them to enjoy their meals with privacy and dignity.
Care plans directed staff on how to help people manage continence issues in order to maintain dignity. We saw that people's clothes, nail and hair care indicated they were supported to present themselves as they would wish. Furnishings in private and communal rooms were clean and presentable.
Is the service responsive?
Care records showed people's needs were assessed before they began living in the home. Care plans were clearly based on these initial assessments, and subsequent monthly reviews. People had signed to show they had been involved in agreeing their needs and how they were to be met, or relatives had done so on their behalf. A person who lived in the home told us they were fully involved in aspects of management of two primary medical conditions they had.
Care plans emphasised the importance of people having the time to make choices. They addressed people's communication abilities and level of understanding. This included recognising people's abilities might change from day to day or at different times of day. Plans gave detailed practical guidance on the nature of support people needed. This showed the planning of care was responsive to individual needs and preferences. Care plans for all people in the home contained details of wishes in respect of end of life care. This subject was addressed in a consistent manner, with the involvement of people's family or other advocates at the start of a person's stay at the home.
People told us they could always request alternative meals to those on the menu, and often did. We saw the chef was proactive in ensuring people were provided with the meals they wanted, and checking their satisfaction.
Care records showed good information was obtained from people and their families about previous lifestyles, experience and interests. The home had a monthly programme of singing and exercise sessions led by external visitors. An activity coordinator on the staff team arranged small group and one-to-one activities to provide stimulation through the week. However, we have drawn the provider's attention to a lack of recording of the incidence or effectiveness of activities. People's social and activity needs were not included in care plans, which meant the home was not reviewing how these needs were being addressed.
Is the service well-led?
The manager saw it as part of their role to speak with all people who lived in the home, and visitors, every day. They undertook a monthly programme of audits, which gave them a factually based oversight of how various aspects of the home were being managed. This meant they were continuously aware of the quality of service offered by the home and could address any shortfall revealed through audit. People told us the provider spent two or three days per week in the home and the manager described a close working relationship with the provider, including annual development planning.
People who lived in the home, with visiting relatives, had quarterly meetings when they discussed the quality of service they experienced. Minutes showed food and activities were always discussed and people were invited to give ideas for improvement. There were annual questionnaire surveys of staff and the relatives of people who lived in the home. We saw examples of changes made in the service as a result of feedback received through these avenues.
Staff had meetings every month, covering care and operational issues. Staff we spoke with said they felt management listened to their views and kept them well informed of developments and plans. They expressed a strong identity as a team working together to meet the needs of people who lived in the home. A care assistant told us, 'The manager has made a huge difference, inspecting and pulling us up. People are open in meetings.' The manager and deputy manager had recently attended training on changes in the regulatory requirements of their role, which showed a value was placed on maintaining good leadership of the service.