Archived: The Dower House

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People we spoke with told us they felt that their dignity was respected and they were involved in making decisions about their daily life. They considered they were well protected and supported. We observed that people were free to spend their life as they wished. One person told us, 'I feel at total peace living here. The staff are very trustworthy and recent changes have made it even better'. We saw records that informed us that a person living with dementia was cared for effectively by staff who responded to their dignity and protected them from harm. The registered provider and registered manager reviewed any incidents and discussed any improvements amongst the staff team. Staff understood generally about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and how they would be put into practice in the service. No applications had been submitted and the management agreed that an awareness update for all staff was needed.

Recruitment practice had been improved and was safe and thorough for new starters. The checks required by legislation had been carried out before the applicant cared for people who used the service.

Is the service caring?

People we spoke with told us that staff treated them kindly and that their individual needs were met. We saw in records that people's care was regularly reviewed with them and that they were encouraged to be as independent as they wanted to be. The registered manager had made changes to the staffing structure and compliment of the home. There had been an emphasis on respectful behaviour and positive attitudes towards people who used the service. People told us that their relative was encouraged to make their views of the care known to staff. Complaint records told us that the registered manager had responded promptly when any concern had been raised. This showed that staff listened to people and cared about them if they were unhappy with anything. Staff told us they always wanted to do what was right for people.

Is the service responsive?

We saw that people's views had been sought through an annual survey. This meant that people could express their views anonymously if they wished. The registered manager and registered provider were in day to day contact with people so any issues were discussed on an informal basis as and when they occurred. We saw records that told us a person's ability to make decisions had been considered. Contact with other health professionals ensured that the person received the external professional support they required. This meant people were supported to express their views and staff were responsive to their needs to enhance their well-being.

Is the service effective?

People's on going needs were regularly re assessed and care planned with them. The registered provider had received information from the funding authority where it had not been possible to visit the individual in person before admission. However, the registered manager agreed that records for pre admission assessments could be more thorough. People told us they had been satisfied with how they were admitted to the service. They said they had been asked about their preferences, choice and wishes before they moved in. Staff we spoke with showed that they knew people's needs well. This meant people were supported to maintain optimum health and well-being.

Is the service well led?

The registered provider and manager had reviewed the culture of the service and had made improvements where required. This showed that a more open, positive and sharing atmosphere was present in the home. People told us the changes had been very welcomed and that they felt things were, 'Even better than before'. We saw that a complaint raised had been responded to and resolved for the individual. This showed the service responded and learnt from mistakes.

The management team had reviewed their systems and were starting to put more robust action into place. This would monitor the service more intensely and record these overviews more accurately. For example, the system to assess and monitor that there were sufficient numbers of staff, with the right competencies, skills and knowledge to meet people's needs was improved upon and in place. We saw that staff practice was monitored and questioned and concerns dealt with through the appropriate channels. This meant the service had implemented a more inward looking practice and had recognised the need to improve their management systems to lead the home better.

People considered there were enough staff on duty to meet their current needs. They said, "I have no complaints and I get the help I need". People considered that improvements to the service had been made.

Staff considered that management systems were more robust. Staff were aware of their roles and responsibilities and had more time to carry out their duties well.

People told us they were consulted about their care and the service provision daily. They said that recently they had been asked on a more formal basis through an individual review.

The provider had taken appropriate steps to ensure that the service was effectively managed and could be responsive to people's changing needs.

People considered there were enough staff on duty to meet their current needs. They said, 'I have no complaints but if I needed more help I'm not so sure'. Staff told us there had been 'Staffing issues' which they were working through. We were told shift cover, roles and responsibilities were being made clearer.

The majority of people told us they were asked on a daily basis if they were OK but no formal meetings or surveys were in place to gain their views about their care or how the service was run.

The provider acknowledged the need to monitor the service more robustly. The systems in place did not enable them to identify problems swiftly and act upon them to keep people safe at all times.