We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well-led?
This is a summary of what we found -
Is the service safe?
There were policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. No applications had been submitted to deprive anyone of their liberty. We noted staff restricted people's access to the kitchen at times, as they had concerns one person may come to harm. This action had not been authorised and prevented others from going into the kitchen when they wished to. This meant proper processes had not been followed in relation to the Mental Capacity Act 2005.
We looked at a range of records as part of our visit. We found people's personal records, such as care plans, were not always updated in a timely manner. This meant there could be inconsistencies in the way their care was delivered. Records overall had not been managed in a safe and organised manner. This made information difficult to find and unreliable.
There were enough staff on duty to meet people's needs. The staff we met and spoke with during the inspection were knowledgeable about people's needs and had established good rapport with people. We observed they were responsive to people's needs and provided care in a timely manner.
We looked at staff recruitment practice. We noted some gaps to required checks in one of the files we read. There were no references for the member of staff, to verify their conduct in previous employment and suitability to work with vulnerable people. This may have placed people at risk of harm and meant we could not be confident appropriate checks were always undertaken before staff began work.
Rotas showed temporary staff were regularly used at the home. These staff had been supplied by the provider's staffing agency. However, there was no documentation at the home to verify their skills and experience. This meant we could not be certain people were always cared for, or supported by, suitably skilled and experienced staff.
Is the service effective?
Staff completed a thorough induction, in line with the nationally-recognised Skills for Care induction. This meant staff were given an appropriate introduction to the care sector and the skills and attributes necessary for their role.
The provider had a programme for the on-going learning and professional development of staff. Records showed staff had not kept their training up to date. An analysis of training needs showed 12 staff needed to complete over 60 courses collectively, to bring their learning up to date. In some case, updates were overdue by several years. This showed staff had not received appropriate professional development.
Staff had not received the support and guidance required for their jobs. Supervision frequency was below the provider's minimum standard of six sessions a year. Only two staff meetings had been held in the past year. This meant staff were not provided with regular opportunities for personal development and to share ideas, to improve practice at the home.
Is the service caring?
People's needs were assessed but information had not always been updated in care plans to ensure they reflected their current circumstances. This meant there could be inconsistencies in how people's care was delivered.
When we visited the service in May 2013, we were told work would take place to produce care plans in formats which people could understand. During this visit, we found no progress had been made to achieve this. This meant the provider had not made reasonable adjustments to reflect people's needs.
We looked at one example where a person was prescribed calming medication. Staff were knowledgeable about the person's needs and the reasons why the medication was prescribed. They told us, and records confirmed, the medication was rarely used. This showed the person's care was delivered in a way that was intended to ensure their safety and welfare.
Risk assessments had been written for a range of activities and situations. For example, moving and handling, going into town and making hot drinks. These assessments had been written or reviewed within the past year. This helped reduce or control the potential for people to experience harm.
Is the service responsive?
People's privacy and dignity were respected at the service. We observed people were supported to look well presented, clean and tidy. Staff knocked on bedroom and bathroom doors before they entered, to safeguard people's dignity. All personal care was provided in private and people had single rooms. This ensured their privacy and dignity were promoted at the home.
People were supported in promoting their independence and community involvement. During the two days of inspection, we observed people were supported to go out into the community. This ensured they maintained links with the community and engaged in regular activities outside of the home.
Is the service well-led?
The provider had a system of carrying out annual quality assurance audits of its services. The annual audit for Buckingham Road was in progress on the first day of our inspection. We spoke with the staff carrying out the audit about their findings. They had noted areas where practice needed to be improved at the home. An improvement plan had been written by the second day of our visit, outlining the actions needed and timescales for completion. We saw prompt progress to ensure matters were put right.
The provider had a system to regularly assess and monitor the quality of service that people received. However, we saw this was not fully in place at Buckingham Road. We found monitoring of the service had not been undertaken monthly by senior management, as expected by the provider. This meant the quality of care provided at the home had not been regularly assessed and monitored, to ensure it was meeting people's needs.