We carried out an inspection on the 31 October 2013 and found that the provider was not meeting the regulations for the management of medicines and records. The provider wrote to us and told us what actions they were going to take to improve. During this, our latest inspection, we looked to see what actions had been taken. Below is a summary of what we found. The summary is based on our observations during the inspection. There were four people living at the home on the day of the inspection but due to their complex health needs they were unable to speak with us apart from one person. We observed how most people were supported to help us understand their experiences of care. We spoke with two members of staff who supported people, the manager who was supporting the inspection process and two relatives by phone after the inspection. We looked at two people's care records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
The relatives we spoke with told us their relatives were safe living in the home. One person said, "I do feel safe here". The interaction between people and staff were good and friendly. People responded to staff in a confident manner and staff were able to understand people's needs through their body gestures and knowledge of people. We asked a member of staff what they would do if they saw someone being abused. The member of staff was clear by saying they would, "Report it to the manager" This meant that people could be confident that staff would know how to keep them safe.
The home had policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to people who lack capacity, and how decisions should be made in their best interests. The manager had a good understanding of MCA and DoLS and confirmed that there had been no DoLS applications submitted to the local authority. All the staff we spoke with told us they had received training in the MCA and DoLS and they were able to explain it to us. Records we saw confirmed the training had taken place and that more training was planned shortly.
We found from our previous inspection that medication was not secure. We found that improvements had been made to ensure medicines were now more secure. This meant that where people were being administered medicines, they were now being stored
securely.
Is the service effective?
We saw that the appropriate care records were in place that showed the service was effective. This included support plans and health action plans. These documents ensured that people's needs were being identified and the service was effective in meeting their needs. We found that people were able to go out of the home when they wanted with the appropriate support from staff. Records showed that people were able to shop for the clothes they wanted to wear and the food they wanted to eat. This meant that people were able to receive the support detailed in their support plan and make choices about how they were supported.
We found that where people needed support from health professionals this was available. The provider was currently changing how this was recorded as part of how they worked with the local authority. Records showed that people were able to make appointments with the dentist or optician. One relative said, "X is able to see a dentist when he needs one". This meant that people were able to see health care professional as part of meeting their health and wellbeing.
Is the service caring?
We found the environment that people lived in to be very family orientated and caring. For example, personalised bedrooms and the home was laid out like a traditional home rather than a residential home. Staff had a good understanding of people's needs and were also able to explain the personal differences between people. Where people were able they were encouraged to do as much as they could for themselves as part of developing the independence. We observed someone in the kitchen during lunch time helping to prepare the lunchtime meal. This meant that people could be confident that staff knew how to support them appropriately.
One person we spoke with told us how much they liked living at the home. Our observation was that staff were very caring in how they spoke to people and offered them support and encouragement. The staff all had a good understanding of how to communicate with people who had complex care needs and were able to read people's body gestures to support them appropriately. This meant that staff were caring in how they supported people.
Is the service responsive?
We found that since our previous inspection records were now kept securely. The provider had taken the appropriate steps to ensure all the areas that needed improvement were addressed. Records showed that one of the improvements made was to ensure staff were clear on their role when administering medicines. This meant the provider was able to ensure they were responsive in delivering an appropriate service.
Relatives we spoke with told us that communication with the home was good and they were always kept up to date with information related to how people were being supported. This meant there was good communication processes in place to ensure relatives were kept up to date.
Is the service well-led?
The service was led by a registered manager. During the inspection process they were supportive and assisted us with any information we needed.
We found that the provider had a system in place to allow them to learn from events like accidents, incidents and complaints. All the relatives we spoke with confirmed they knew how to make a complaint and the process was displayed in the home. This meant that there was a system in place so people or their relatives were able to share any concerns they had.
We found that the provider had quality assurance processes in place to gather views needed to improve the service. We found that there were appropriate audits taking place as apart of the provider ensuring the appropriate quality of service provision was being delivered.