This inspection was carried out by a CQC inspector. We spoke with five people who used the service, three relatives, three staff members and the registered manager. We also reviewed records relating to the management of the home which included three care records, daily care records, incident reports, staff training records and minutes of staff and residents meetings. We used the information to answer the five questions we always ask: Is the service safe?
A robust safeguarding procedure was in place. Staff used imaginative ways of involving people in awareness of safeguarding to ensure they were safe.
People gave consent to the care and treatment provided for them. Complex decisions had been made with people who knew them well and able to act in their best interests. A relative told us they had been involved in a complex medical decision. They told us, "Staff are superb, they have supported us through a very difficult time." The provider had acted in accordance with the Mental Capacity Act 2005.
We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospital and care homes. The service had procedures in place and the manager knew how to apply for this authorisation. We found that applications had been made under DoLS procedures for three people who used the service. The service was waiting for replies from the best interests team of the local authority in relation to their applications. No one at the time of our inspection was subject to DoLS.
Is the service effective?
People told us that they were happy with the care they received and felt their needs had been met. We observed that staff had positive engagement with people and understood their support needs. People led active lives with a focus upon community involvement. A relative told us, "Staff encourage X to join in activities. They have the time and there are always enough staff on duty." Another relative told us, "I could not fault them (staff) at all. I would be confident if no-one was around that they would care for X with dignity, care and concern."
Is the service caring?
Staff were able to describe the good practices they used to ensure that people's privacy and dignity were respected. We observed that staff engaged in meaningful conversation with people. Each person received the same caring responses from staff and were always included in conversations.
A relative told us, "My relative has been in hospital. Staff phone daily and encourage us in planning (their) return home. They provide dedicated, thoughtful care."
People using the service, their relatives and friends completed an annual satisfaction survey. They expressed high levels of satisfaction across the service including relationships with staff.
Is the service responsive?
We saw from the reviews of people's care needs that plans of care had been adapted when there had been a change in the persons needs or wishes. People's goals and objectives in their annual review had been reviewed each month throughout the year to ensure they were met.
People had activities and contacts with relatives and friends that were important to them. Staff supported them to maintain those relationships.
If people's health needs changed external health professionals had been contacted. Their advice had been recorded and treatment plans put into place.
We saw that the service had responded to information from people using the service, their representatives and staff. This improved the service.
Is the service well-led?
Regular staff meetings had been held. Staff told us they had been able to raise any concerns they had. We saw that regular supervision and appraisals were part of the support that staff received. They told us that they were listened to and were well-supported by the manager and colleagues.
Staff told us that the registered manager worked alongside them and they could raise areas of concern at any time. There was an after-hours on-call system. Staff said they could speak directly with a manager out of normal office hours.
The service had a quality assurance system and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.