At our last inspection we found that there were not enough qualified, skilled and experienced staff to meet people's needs. The provider sent us an action plan that set out their intention to improve in this area. At this inspection we found that improvement's had been made.During our inspection we spoke with eight people, five people's relatives and three visiting professionals. We also spoke with 11 care workers and the registered manager. We reviewed six peoples care files and documents made available to us by the manager around staffing levels and quality assurance. We also carried out a short observational framework for inspection (SOFI). This is used to capture the experiences of people who use the service where they may not be able to express this for themselves.
We considered our inspection findings to answer questions we always ask;
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well-led?
This is a summary of what we found;
Is the service Safe?
The service was safe because staff understood the needs of the people they supported. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.
At our last inspection we found that there were not enough qualified, skilled and experienced staff to meet people's needs. At this inspection we found that improvements in relation to staffing had been made. We concluded that there were an appropriate number of staff with the necessary skills and experience to meet people's needs.
Appropriate arrangements were in place for obtaining and disposing of medicines safely. Medicines were stored safely in a locked cupboard and medicine trolleys which were secured to the wall when not in use. Staff had received management of medicines training. Suitable records were kept regarding medication administration. The home had appropriate systems in place to account for the amount of medicines given and for those left in stock. We saw that the amount of medication documented as being in stock on in the controlled drugs chart corresponded with the actual amount of medication in stock. This meant that medicines were handled safely and securely.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. While no applications have been submitted, proper policies and procedures were in place but no applications had been necessary. Relevant staff have been trained to understand when an application should be made, and in how to submit one. This meant that people's human rights were properly recognised, respected and promoted.
Is the service effective?
The service was effective because people told us they were happy with the care they received and felt their needs were understood and met. People's relatives were also complimentary about the care their relatives received. Our SOFI observations identified a number of warm and meaningful interactions that visibly had a positive impact on people's mood. One visiting professional told us, 'I have been seeing some of the people here for some time and have seen amazing improvements in people's self-esteem'.
Is the service caring?
This service was caring because people we spoke with felt cared for. One person told us, 'they [the staff] are wonderful, they understand me and know what I need.' Relatives we spoke with were also complimentary of the care their relatives received. One relative told us, 'If I only say one thing, it's amazing, the care here is amazing.' We observed a number of caring, warm and patient interactions between care workers and the people they supported.
Is the service responsive?
The service was responsive because people's needs were assessed when entering the home and were subject to on-going review of their needs. When people's needs changed the service responded and took the appropriate action. For example, advice and guidance was sought from other professionals when required. People's hobbies and interests were identified. We saw that people's lifestyle choices and religious beliefs were respected. People were offered a number of activities to participate in and also had access to music therapy.
Is the service well led?
The service was well led because staff we spoke with felt they had clear leadership from the registered manager who always had their door open and would listen to any concerns.
Robust systems were in place to monitor the quality and safety of the service. Systems in place ensured that care files were kept up to date and people's care plans/needs were reviewed. These systems also ensured that staff received regular training and support.
Where issues were identified appropriate action was taken. People told us they completed satisfaction surveys and attended relatives meetings. Actions from these meetings were carried out to make improvements to the service. We were told that the management consulted with people who lived at The Homestead as well as staff before changes were made.