Our inspection team was made up of an inspector and an expert by experience in relation to care for elderly people and people with dementia. They helped answer our five questions.Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People were treated with respect and dignity by most staff. We saw mainly good examples of how staff treated people with dignity and respect. However, a small number of staff did not refer to people by their preferred name. Not all staff wore name badges which meant that people could not always name staff. One person told us, "The staff are so nice to me but I don't know their names."
People told us they felt safe. They told us that staff usually responded quickly when they used their call alarms. One person told us they had waited "a long time" when they had used their alarm. The registered manager told us that call response times were not monitored.
People told us that they knew how they could raise concerns but one person expressed a lack of confidence about doing so. They told us they were worried about "being in the doghouse if they [staff] knew what I was saying." We spoke at length with the person but they did not raise any concerns that required action.
People received their medications at the right time. The provider had effective arrangements for the safe management of medicines.
Training records we looked at showed that most staff had received training about safeguarding vulnerable people. Staff we spoke with understood how to identify and report signs of abuse. Procedures were in place for managers and staff to learn from events such as accidents and incidents, complaints and staff concerns.
The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. However, of 46 staff involved in providing care, only a third had received training about MCA and DoLS.
The provider employed housekeeping staff who cleaned the home. We saw that people's bedrooms and communal areas were clean and tidy. One person who used the service described the home as "spotlessly clean."
Equipment used to assist people with transfers and mobility had been serviced and maintained. Staff had been trained to use that equipment. We saw staff using the equipment safely and effectively. This meant people were not put at unnecessary risk of harm.
The registered manager and administrative staff set staff rotas. People's care needs were taken into account when making decisions about the numbers and skills and experience of staff required.
Is the service effective?
People’s health and care needs were assessed with them or their relatives. Care plans included details of people's needs but information about how people were supported with those needs lacked detail. We saw care plans that included statements that people required support with their personal care but we saw no information about how they had been supported.
When we spoke with relatives they told us they were confident that the service provided good care. One relative told us, "I've no concerns whatsoever. The staff complete all the care routines they should." However, the quality of record keeping meant we could not always find evidence that routines had been completed.
People's nutritional needs were met and people who required support with eating their meals received appropriate support. However, we found that accurate records of people's fluid intake had not always been made.
Visitors were able to see people in private and visiting times were flexible.
Is the service caring?
People told us they were supported by kind and caring staff. One person told us, "All the staff are very kind." Another person said, "Most of them care for me and are lovely." We saw that care workers showed patience and gave encouragement when they supported people. Most staff used people's names when they spoke with them, but some staff used terms such as "chick", "sweetie" and "darling". We saw a person's request to be lifted and made more comfortable not acted upon.
People we spoke with were complimentary about the staff. One person said , "You couldn't better it. The staff are lovely. They come at night to see I'm comfortable." A relative of another person told us, "I am very pleased with the care for my wife, the care home is excellent."
People’s preferences, interests and diverse needs had been respected. People who wanted to be were supported with their religious and spiritual needs. People had newspapers of their choice to read. The home provided a range of communal and individual activities that people participated in.
Is the service responsive?
People told us that staff supported them with their needs. People told us they were well looked after. Most records we looked at showed that people had been supported with personal care and health needs. However, the quality of record keeping varied and a small number of records were incomplete or lacked detail. Where records lacked detail it was difficult to find evidence that people had been supported to the full extent of their care plan.
Most relatives we spoke with told us that they knew how to raise concerns and were confident they would be listened to. We saw that relative's complaints had been investigated and resolved. One relative wasn't sure about what the complaint's procedure was but they had no concerns.
All relatives we spoke with told us that the service had kept them informed about their parents or spouse's welfare.
People who used the service and relatives had participated in a satisfaction survey. The results of the survey showed that people were satisfied with their care. Relatives told us that their views had been acted on.
Is the service well-led?
The service had a system for monitoring the quality of service. This included checks of documentation and records.
The provider had carried out a survey of people who used the service. The survey gave people an opportunity to comment on their experience of the service.
A provider is required to report to us, without delay, instances of people being injured. We found there had been an instance of a person suffering a potentially serious injury several weeks before our inspection that we had not been informed about.
Some staff had been subject to disciplinary action because of inappropriate care practice and unprofessional conduct. We received information from two staff who expressed no confidence in the provider's willingness to look into concerns they had.