This inspection took place on 12 November 2014 and was unannounced.
Aigburth is registered to provide personal care and accommodation for up to 56 older people, some of who are living with dementia and physical disabilities. At the time of our inspection there were 47 people using the service. The home is purpose built and all the bedrooms are single with en-suite washrooms. There was a lift and a set of stairs to access the first floor The garden was easily accessible to people with limited mobility or for those people who used a walking frame or wheelchair.
At the last inspection on 16 May 2014, we asked the provider to take action to make improvements to the storage, administration and management of medicines and the management of complaints. During this inspection we found that the management of medicines and complaints had improved.
A registered manager was in post. 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.
Since our last inspection in May 2014 a number of concerns had been brought to our attention with regards to the health, safety and wellbeing of people who used the service. At the time of this inspection the local authority’s safeguarding team continued to investigate concerns about the service. The provider was working with the local authority that was monitoring the service’s action plan to ensure that people’s needs were met and improvements sustained. This included monitoring the impact of new admissions which were being phased in gradually.
People told us that there had been an improvement in the consistency of care staff and that agency staff were no longer used. People and relatives of people who used the service told us that they were satisfied with the care and support provided, but there were times when sufficient numbers of staff were not available. We saw that the allocation of staff and staffing levels were not effectively co-ordinated or managed at busy times of the day and during unplanned staff absences. Staff worked over three floors in order to meet people’s care needs. However, staff availability at lunchtime on two of these floors was limited because all the meals were being served at the same time and there was not enough staff to help. Three people who needed support to eat their meals had a cold meal because staff were not available to support them in a timely manner. One person who needed prompting and guidance at lunch time was not supported because staff were busy helping others. This meant that not all people were receiving the support they needed at meal times to maintain their health and wellbeing.
We received mixed comments from people who used the service about the quality of meals provided. Some people gave positive comments but others felt the quality of meals could be improved. People identified at risk of malnutrition had been referred to the dietician and prescribed food supplements and fortified diets. The chef had information about people’s dietary needs and was due to attend further training in the nutritional needs for older people.
We viewed five people’s care records. We saw that assessments of their needs had been undertaken and plans of care developed and reviewed regularly providing clear guidance for staff to follow. Records showed that people’s safety had been considered in the delivery of care.
People received their medicines at the right time. Staff were trained and their competence to administer medicines had been assessed. The provider had taken steps to ensure the management; storage and administration of medicines were safe.
People were supported to maintain good health. Records showed people’s health needs were met by health care professionals. Staff sought medical advice when there were any concerns about people’s health and knew the procedures for reporting accidents and incidents.
Staff recruitment records showed that staff had undergone a robust recruitment process. A staff training matrix we looked at and discussions with staff showed that staff were provided with training appropriate to their job role in the delivery of care that promoted people’s health, safety and wellbeing.
People who used the service and relatives of people who used the service told us that they were satisfied with the care provided and that they felt safe. People were confident to speak with staff if they had any concerns or were unhappy with any aspect of their care. Staff had undertaken training in promoting people’s dignity and rights and knew how to protect people under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguard (DoLS).
People told us that they were treated with care and compassion and that staff treated them with dignity and respect. Our observations confirmed this to be the case.
Staff had a good understanding of the needs of people and supported them to take part in activities that were of interest to them. A weekly religious service was held and the home organised social events and entertainers. The home also used volunteers from the community that helped with activities and planned social events.
There were effective systems in place for the maintenance of the building and equipment which ensured people lived in an environment, which was well maintained and safe. Audits and checks were effectively used to ensure people’s safety and their needs were being met. The provider acted on concerns and complaints and encouraged feedback on the quality of service and care provided.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.