This inspection was carried out by a CQC inspector. We spoke with five people who used the service, three relatives, three members of staff and the registered manager. We also reviewed records relating to the management of the home which included four care records, daily care records, medication records, staff files and training records and minutes of meetings. We used the information to answer the five questions we always ask: Is the service safe?
Care records had been reviewed and re-written since our last inspection. This included risk assessments. This ensured that there was a current profile of risk for each person and staff had the necessary information to keep people safe.
People received effective and safe support to take medicines they had been prescribed because detailed and accurate records had been kept and evaluated by senior staff. Staff had regular assessments of their competency to administer medicines. This meant that people were protected against the unsafe use and management of medicines.
An effective staff recruitment and selection process was in place. Appropriate references and checks had been undertaken to ensure that staff were suitable to carry out their work. Staff had appropriate induction and training to ensure they had the skills and competencies to care for people safely.
A relative told us, "X has had several previous placements that were unsatisfactory. But we are very pleased with the care they now receive. We feel that X is safe now."
The service had made changes for people who may present risks to themselves or others. Incidents had been scrutinised and changes made to risk management plans with alternative strategies to de-escalate potentially serious incidents. Staff told us and records showed that the number of incidents requiring physical interventions or medication to manage serious incidents had significantly reduced. This meant the risks to people had been reduced.
We monitor the operation of the Deprivation of Liberty Safeguards 2009 (DoLS) that apply to hospitals and care homes. One person had been made subject to a restriction under DoLS since our last inspection to ensure their health and safety. The service had made other applications under DoLS procedures and were awaiting replies from the best interests team of the local authority in relation to the applications.
Is the service effective?
People's health and care needs had been assessed, records reflected the correct level of support people needed. Care records had been reviewed monthly and any changes to individual needs had been reflected in care records and risk assessments.
Each person had a health action plan to record their health needs and to ensure their continued good health and wellbeing. A range of health care professionals had been involved to meet people's needs. The service had established a regular dialogue with the GP surgery and health professionals. Care and treatment plans had been established and followed. We saw that the service had been pro-active in pursuing health issues. This ensured that people had the necessary care and treatment to meet their health care needs.
Annual reviews recorded people's goals and objectives. These had been reviewed subsequently at three monthly and also monthly reviews. Monthly audits by the provider's quality manager had included checks on the objectives set at the person's annual review meeting.
Is the service caring?
We observed natural and relaxed conversations and interactions between staff and people who used the service. People responded well to staff, who were sensitive and caring in the support they provided. We saw that staff had a good understanding of how people were feeling and were able to respond to what they needed.
We spoke with five people and asked their opinions about staff and the support they received. Feedback was positive. One person told us, "I really like the staff they are good to me they are friendly and helpful. I am happy with everything, I like living here."
Staff were able to give us examples of the good practices they used to ensure that people's privacy and dignity were respected. We saw that staff treated people with care and compassion. People were listened to, their views were sought and their wishes respected. People could be confident that their needs would be met.
Is the service responsive?
When people's health care needs changed external health professionals were contacted. Their actions and recommendations had been recorded and acted upon.
Regular weekly meetings had been held with people using the service. We saw from minutes of the meetings that people's views had been sought about a range of matters including activities, menu planning or any changes they wished to make about daily routines. We saw from a summary of the annual questionnaires completed by people who used the service and relatives that suggestions made had been acted upon to change and improve the service to people.
We saw that suggestions made by staff in team meetings had been acted upon.
Is the service well-led?
People told us the manager and staff were approachable and helpful. A relative told us, "Staff keep us informed about any developments relating to X. We have the same positive response whichever staff are on duty. We know we can speak with the manager at any time."
Staff told us they were involved in discussions about the service and were asked for their views. They felt listened to. Staff told us they felt that they were valued and any suggestions they made were considered. We noted a commitment and pride in their work and being part of the positive changes that had been made over the past year to improve aspects of the service.
The provider had a quality assurance system of checks and audits in place to monitor the quality of the service. We saw that opportunities to change things for the better had been addressed positively. As a result the quality of the service was continuously improving.