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 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.
This is a summary of what we found:
Is the service safe?
Care records and risk assessments identified the support people needed to keep them safe. Other health and social care professionals were contacted for advice to keep people safe. People we spoke with confirmed their care plans were an accurate reflection of the care they needed and received.
Staff had received training about safeguarding and the Mental Capacity Act 2005 and knew what to do as a result of a safeguarding concern. Staff managed the finances for one person. Records were kept of transactions but these were not being checked for evidence of financial abuse.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Care staff knew how to recognise someone being deprived of their liberty and actions to take as a result. Any restrictions in place were documented and justified in people's care plans.
Medicines were stored and administered safely. We found, however, that balance checks were not being completed to identify whether the correct number of tablets were in stock. The registered manager told us this would be done on an ongoing basis. Staff competency was assessed before they took responsibility for administering medicines.
Is the service effective?
People's health and care needs were assessed. This involved the person where possible. One person told us they had been involved in putting their care plan together and another person said they had not wanted to be involved. Staff were aware of changes in people's needs and shared these with colleagues. A social care professional told us the service supported people to be as independent as possible by supporting people to take appropriate risks.
We found care records contained relevant information but were not structured in a logical way to help staff find the information they needed. For example, one person's care record contained a number of risk assessments that related to the same risk and it was not clear which one should be followed. The registered manager told us they were looking at approaches to help them bring all the information together in a logical structure
The majority of staff had received the training identified as necessary by the provider. A small number of staff were awaiting training. Condition specific training, for example dementia and the management of challenging behaviour, was also provided for staff. People told us the number of staff on shift allowed their needs to be met. One member of staff told us 'I love working here'. They told us they felt they had received enough training and had the opportunity to do more condition specific training as required.
Is the service caring?
Feedback from people included 'always help me when I need it', 'the home is alright' and 'I like it here. It's better than anywhere else I've been'. All the interactions we observed between people and staff were patient, caring and professional. People clearly enjoyed the relationship they had with staff.
People's preferences, interests, wishes and diverse needs were noted in their care records. Staff spoken with had a good understanding of how people wished to be supported and provided care in accordance with their wishes.
Is the service responsive?
As people's needs changed the service adapted to accommodate them. Other health and social care professionals were involved when needed to assess people's needs and provide guidance and support. Risk assessments were produced in response to problems that occurred. Senior staff were also producing risk assessments before problems occurred using a knowledge of people's needs and history.
Senior staff understood the need to identify the goals people wanted to achieve but had not fully understood how this could be reflected in someone's care record. Staff were aware of people's goals but it was not clear how they were being supported to achieve them. The registered manager told us they would review the recording and monitoring of people's goals to improve the outcomes for them.
There was evidence that learning from incidents took place and appropriate changes were implemented. We found there was no system for recording the learning process and the registered manager acknowledged this may be helpful for consistency and record keeping.
Is the service well led?
A quality assurance system was in place which included gaining the views of people who lived in the home. People said they had been listened to when they made a complaint. We were told by people they had house meetings to discuss issues important to them such as food and activities.
The administration and storage of medicines was not being routinely audited to check policies were being followed. Other audits were in place to monitor the safety of the environment people lived in. Business continuity plans were in place to mitigate the risk from major incidents such a fire, utility loss and burglary.