We carried out an inspection to help us answer five questions; Is the service caring?
Is the service responsive?
Is the service safe?
Is the service effective?
Is the service well led?'
Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with four people using the service and one of their relatives, four care staff supporting them and looking at four care records and four staff records
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If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
People who used the service and their relatives told us they felt safe. Safeguarding vulnerable adult procedures were in place and staff understood their role in safeguarding the people they supported.
We found that the provider had policies and processes in place to ensure that people rights were protected in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We found that staff had training in how to protect people's rights and gain their consent.
We found that people's care records showed that risks to individuals had been assessed but did not have appropriate plans in place to prevent harm to people. We found care staff were not aware of the risks associated with delivering care and support.
The registered manager ensured that staff rotas were planned in advance to maintain the required staffing numbers. The provider had recruitment systems in place to ensure that staff were of good character and had the necessary skills.
Robust systems were not in place to make sure managers and staff learned from events such as accidents, incidents and complaints. This increased the risk to people and failed to ensure that lessons are learned from mistakes.
Is the service effective?
People's care needs had been assessed but appropriate plans to meet their identified needs were not always in place. Some of the care plans had not been regularly reviewed and staff could not support people's needs as required.
People told us they were able to see their visitors in private if they wished and that visiting times were flexible.
Care staff received the appropriate training to meet the diverse needs of people who used the service.
Is the service caring?
People were supported by staff that were kind and caring. We saw that care staff gave people encouragement and were patient with them. One relative told us, "The staff are very calm and have patience".
People using the service had completed an annual satisfaction survey. There were some shortfalls and concerns that had been raised. The registered manager was unable to tell us what actions had been taken to address these shortfalls.
People's preferences, interests, aspirations and diverse needs had not always been recorded. This meant that care and support was not always provided in accordance with people's wishes.
Is the service responsive?
Care staff told us they had raised concerns about people's changing needs with the registered manager but that they were not always responded to. We found that staff had raised concerns in staff meetings. The registered manager was not able to tell us what actions they had taken to resolve these concerns.
People who used the service had made requests for changes to the service provided. These requests had been recorded but no action had been taken to meet those requests.
Is the service well led?
The registered manager was not able to provide us with any information on how they managed or identified risks. The quality assurance checks that were made contained no information about what was checked and what was found.
Where concerns had been raised by care staff and people who used the service, the registered manager had not investigated these concerns or resolved them.