The inspection took place on 20 and 21 June 2017 and was unannounced on the first day.The home provides nursing and personal care for up to 129 older people, some of who are living with dementia. There were 124 people using the service when we inspected. The home has six separate units; Garden wing provides nursing care for up to 24 people living with dementia; Margaret wing provides nursing care for up to 23 older people; Terraces provides nursing care for up to 26 older people; Constance wing provides nursing care for up to 24 older people living with dementia; Alexandra wing provides personal care for up to 17 older people living with dementia and Victoria wing provides personal care for up to 14 older people. Each wing has its own communal areas including lounge and dining space as well as bathrooms and toilet facilities. The majority of bedrooms are single occupancy although there are 14 double bedrooms for people who wish to share. There are well maintained gardens and patio areas around the home, including a secure outdoor space which can be accessed from the Garden wing.
The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At the last inspection in May 2016 we identified three breaches of regulations, Regulation 9 (person centred care), Regulation 12 (safe care and treatment) and Regulation 13 (safeguarding service users from abuse and improper treatment). The overall rating for the home was ‘requires improvement’. During this inspection we checked to see if the required improvements had been made. We found that although improvements had been made the issues raised at the last inspection had not been fully addressed and there were continued breaches of two regulations.
People and relatives told us they felt the home was a safe place to live. We found improvements had been made to the way safeguarding concerns were identified and reported. Staff knew how to keep people safe and report any concerns about people’s safety and welfare. Risks to people’s health and wellbeing were managed effectively.
The management team decided on the staff numbers and skill mix for each unit. However, we found there were sometimes less staff on duty that were required. This meant there was a risk people, particularly those people living with dementia, would not have their needs met in a timely way.
There were robust recruitment procedures in place to protect people from the risk of receiving care and treatment from staff unsuitable to work in a care setting. References were obtained and criminal records checks were carried out but we found the records did not always show that gaps in people’s employment history had been explored at interview. Staff were trained and supported to carry out their roles and responsibilities.
We found overall people’s medicines were managed safely and people received their medicines as prescribed.
The home was clean and fresh and generally well maintained and secure. However, the provider did not have an electrical wiring certificate to confirm the safety of fixed electrical installations.
People’s capacity to make decisions about their care and treatment was assessed and where appropriate applications for Deprivation of Liberty Safeguards authorisations had been made. However, we found while staff were aware of who had DoLS in place they were not always aware of the attached conditions. This created a risk that people’s rights were not protected.
The majority of people were satisfied with the food and we saw staff were patient and sensitive when supporting and prompting people to eat. People were offered a choice of food but people living with dementia were not offered a visual choice which may have helped to inform their choice.
People’s care plans did not always provide clear guidance about the support they needed to have an adequate dietary intake. Food and fluid charts were not always sufficiently detailed to provide an accurate picture of what people were eating and drinking.
People were supported to meet their health care needs and visiting health care professionals we spoke with were complimentary about the service.
People living in the home and relatives told us staff were kind, compassionate and caring. This was supported by our observations throughout the inspection. We saw staff were respectful and paid attention to people’s privacy and dignity.
People who lived at the home and relatives were listened to and we found many examples of changes which had been made in response to feedback from people.
The service supported people to think about their end of life care and had recently held a ‘Dying Matters’ event to encourage people to think about living well and planning for end of life care.
People were encouraged to visit the home before they moved in and their needs were assessed. The home was in the process of implementing new electronic care records with the aim of supporting a more person centred approach to care planning.
Complaints were taken seriously and dealt with and people were told what action had been taken in response to their complaints. However, this was not always fully reflected in the records.
Everyone we spoke with told us they would recommend the home. We found people who lived at the home, relatives and staff had a lot of confidence in the management team.
There was a clear commitment to continuously improving the service and ensuring everyone who used the service experienced good care. However, we found there was still work to be done to achieve this. We found some of the concerns raised at the last inspection had not been fully addressed which meant the service remained in breach of two regulations and we identified two additional breaches in relation to staffing and good governance.
You can see the actions we asked the provider to take at the back of the full version of the report.