A single inspector carried out the inspection. The focus of the inspection was to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People are treated with respect and dignity by the staff. People told us they felt safe.
Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.
The home had proper policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant appropriate measures had been taken to ensure people were safe.
The service was clean and hygienic. Equipment was well maintained and serviced regularly therefore people were not put at unnecessary risk.
The registered manager set the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required of staff. This meant there were sufficient staff with appropriate skills and experience to meet the needs of people.
Is the service effective?
There was an advocacy service available if people needed it, this meant that when required people could access additional support.
People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing their care plans and these reflected their current needs. Care plans were reviewed monthly and people and their relatives were involved in this process.
To detect declines in a person's health, the management had records such as daily food and fluid charts, turn charts, monthly weight monitoring, monthly nutrition assessments, skin/pressure area assessments and warfarin and medication reviews. Staff were able to explain why it was important to complete these records. One person we spoke with told us they felt their health was closely monitored. They told us it felt a bit overwhelming at times but staff always explained why they needed to do these assessments.
Is the service caring?
People were supported by kind and attentive staff. People who used the service spoke with us about their care and were complementary about the staff. They told us the staff were caring and respectful and were always happy to speak with them about anything. We observed staff interact with people in a respectful and caring manner. Staff were noted to adapt their approach according to people's individual needs. One person told us 'The staff are very busy but they never make me feel like a nuisance'. We observed staff spoke with people to get their views on the care provided for them and if there was anything they would like to change.
Before people received any care they were asked for their consent and the provider acted in accordance with their wishes. For those who did not have the capacity to consent, the provider had acted in accordance with the legal requirements.
People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.
People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.
Is the service responsive?
People completed a range of activities inside and outside of the home regularly. There were weekly and monthly timetables of activities for people to participate in. A recent survey showed people had been asked their opinions in activities available and these had been acted on.
We looked at the incident and accident file and noted the high incidence of falls. The home manager had a separate file to monitor and investigate the incidence of falls. Forms had been completed accurately with details of the incident, any injuries and actions taken to reduce the risk of it happening again. Referrals had been made to appropriate services such as physiotherapy, General Practitioner (GP) for a medication review and the wheelchair service. Accident and incident forms were reviewed monthly by the manager. We saw incidents had been documented in the person's notes and risk assessments amended accordingly.
Is the service well-led?
The service has a quality assurance system in place to monitor the quality of the service provided to people. Records we saw identified any concerns were addressed promptly. As a result the quality of the service was continuingly improving.
Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes which were in place. This helped to ensure that people received a good quality service at all times.
People who used the service told us they were well cared for by staff and trusted them to react if they saw any deterioration in their health. Relatives told us the home was proactive in identifying concerns and implementing strategies to address these