A single inspector carried out this inspection and it was completed in one day. We saw all of the people who lived at the home and spoke with nine people and three relatives to gain their experiences of the service.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, their relatives 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?
People were treated with respect and dignity by the staff. People told us they felt safe. Comments included "always polite and respectful" and "everyone (the staff) is kind and polite".
The registered manager sets the staff rotas. These take into account people's care needs when making decisions about the numbers, qualifications, skills and experience needed. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. People told us "you just press the buzzer if you need help" and "always enough staff". This helped to ensure that people's needs are always met.
The home had a homely and friendly atmosphere. People told us it was kept clean and tidy. However, we did find that some areas of the home which were unsafe and unsuitable. This was putting people at risk of unnecessary harm. A compliance action has been set for this. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to ensuring the home is safe for people to live there.
Some systems were in place to make sure that learning from events such as accidents, incidents, complaints and investigations took place. This reduces the risks to people and helps the service to continually improve.
People's care records and risk assessments did not always contain all the information required. This puts people at unnecessary risk of harm. A compliance action has been set for this. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to keeping accurate care records and individual risk assessments.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. During our visit it was unclear whether some people required a DoLS referral due to their freedom and choice being restricted. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to this matter.
Is the service effective?
People told us they were happy with the care and support they received and felt their needs had been met. They told us "it's lovely - wonderful", "everything is lovely" and "you could not get a better place". Their health and care needs were assessed and, for those people that were able, they were involved in the reviewing their care or support plans.
Relatives we spoke with told us they were able to see people in private and always felt welcome by staff. This showed privacy was respected
Is the service caring?
People were supported by kind and attentive staff. We observed how relaxed and comfortable people were with the staff group. Comments included "good care X receives from fantastic staff", "cannot fault the carers at all" and "staff are very good - we all like living here".
People benefitted from a static staff group that were enthusiastic, motivated and enjoyed their work. Staff comments included "we all help each other out" and "we are like a family, it's like home and we love coming to work".
"Is the service responsive?
People's needs had been assessed before they moved into the home. Records showed that some people's preferences, choices and needs had been recorded and care/support plans had been provided which detailed their needs.
The service involved specialist professionals when necessary to make sure people received the appropriate care. One health professional commented "the standard of care good".
People knew how to make a complaint if they were unhappy. People, staff and relatives felt they could voice concerns and they would be listened to.
Is the service well-led?
The service had a quality assurance system in place. The management of the home was open and inclusive. People were regularly asked for their feedback on the service or treatment they received - this ensured that improvement was continually sought.