This inspection was carried out by a single inspector 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 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.
Is the service safe?
People's care was not always delivered appropriately to ensure they were safe in the home. For example, we found that care was not always delivered in a way that fully protected people from the risks of pressure sores on their skin. Also, where a health care professional had made recommendations about how to meet a person's needs in relation to drinking fluids, these had not been incorporated into their care plan or risk assessment and staff gave us conflicting information about how to meet their needs. This put people at risk of not receiving appropriate support.
People were not protected against the risks associated with medicines. We found that medicines were not always stored appropriately in the home and people did not always receive their medicines as prescribed. There were procedures in place for recording medicines but these were not consistently followed. Staff were administering insulin to one person who used the service without having completed suitable training and been assessed as competent to carry out this task. This put people at risk of not receiving their medicines in a safe way.
There was no plan in place to ensure that the Mental Capacity Act (2005) Deprivation of Liberty Safeguards (DoLS) were fully implemented in the home. As a result proper procedures had not been followed to ensure that people were not unlawfully deprived of their liberty.
We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.
Is the service effective?
Although most people we spoke with felt that their basic personal care needs were met, people were not always able to do activities that met their individual needs and preferences. People who used the service, and their relatives, felt that a better range of activities was needed, including opportunities to go out of the care home, to ensure people were stimulated.
People told us that the number of agency staff used in the care home impacted on the effectiveness of their care. They told us that there was a difference between the care provided by permanent staff and that provided by agency staff and expressed concerns about their skills and knowledge. We found that there were not always suitable checks in place to ensure that agency staff who worked in the home had appropriate qualifications, skills and experience to meet people's needs.
Records about how people's needs were being met were not maintained effectively to ensure people received the care they needed at the right time.
We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.
Is the service caring?
Most of the people we spoke with told us that permanent staff who worked in the home were kind, helpful and hard-working. Relatives also told us that they were able to visit the home at any time and always found staff to be friendly and welcoming. We observed staff interacting with people who used the service and saw that they treated people with respect and dignity, offering encouragement and demonstrating an awareness of people's personal likes and dislikes.
One person who lived in the home reported a concern in relation to the uncaring and abrupt attitude of some night staff towards them. They told us that this had made them feel nervous about asking for help. We reported this to the registered manager at the time of our inspection who, in turn, reported the concern to the local authority under local safeguarding procedures. The registered manager has agreed to monitor the situation and provide further training to staff in safeguarding and dignity to minimise the risk of this happening again.
Is the service responsive?
There were not always enough staff available to meet people's needs. People who used the service told us that there were certain times of the day when staff seemed particularly under pressure. For example, one person told us, 'They're all in such a rush because they say they're short-staffed. They say they haven't got time. If I ask for help, they say 'We're busy' and I should do it myself.' Another person commented, 'I don't think there is quite enough especially when they are trying to put people to bed at the same time.' These views were echoed by some relatives we spoke with who told us that more staff were needed to support people with social activities and keep a watchful eye on people who were particularly vulnerable.
We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.
The home responded to changes in people's health and well-being and we saw examples of how staff had contacted the emergency services, people's GPs and the local authority to report concerns about people's welfare. People who used the service were satisfied with the way the home liaised with health care professionals on their behalf.
Is the service well-led?
The provider did not have effective systems for monitoring the quality and safety of the service.
Checks to monitor the safety of the home were not carried out regularly. This meant there was a risk that concerns in relation to the maintenance of the premises, hot water temperatures, call bells, door alarms and fire safety would not be identified and addressed quickly.
There were no action plans arising from a visitors' survey that was carried out in February 2014 or a recent residents' meeting. This meant that the provider was not fully able to demonstrate how they took on board people's views and made improvements to the service based on their feedback.
Accidents that had occurred in the home were recorded but, while we saw that action was usually taken in response to each incident, there was no effective analysis to identify common themes and concerns. This would help ensure that action was taken to reduce risks across the whole service.
Three relatives we spoke with told us that the provider was slow to take action when they had made suggestions about how the home could be improved or requested specific changes on behalf of their family member. They felt that they had needed to apply pressure in order for changes to be made. Some relatives and staff also identified further areas for improvement in the home but did not have confidence that the provider would take action. One person said that they rarely saw the provider speak with people who used the service or their families and felt that this was needed in order for them to show they were listening and responsive to people's views.
We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.