As part of this inspection we spoke with four of the five people who used the service, two 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, staff training records, serious incident reports, medication records, staff duty rosters and quality monitoring documents. We used the information to answer the five questions we always ask: Is the service safe?
People's consent was sought before care and treatment was provided. Where people did not have capacity the provider had followed the principles of the Mental Capacity Act 2005 to ensure that decisions were made in the person's best interests.
There were systems in place to identify, assess and monitor risks. Strategies were in place to reduce risks. Where serious incidents had occurred detailed records had been completed and were reviewed by senior managers to ensure that methods used were appropriate to ensure people's safety. The reviews were used to see if alternative strategies could be used. The service learned from previous incidents.
The medication system in place was safe. All staff had received medication training and the provider's policies and procedures had been followed to ensure people were protected against the risks associated with medicines
We looked at staffing levels to check that people's needs were being met. None of the staff had any current concerns about staffing levels. We found that there had been sufficient numbers of suitably qualified, skilled and experienced staff on duty at all times to support people and keep them safe.
We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. Staff had been trained to know when an application should be made. Correct procedures were in place but no applications had been needed or submitted since our last inspection.
Is the service effective?
Detailed plans of care had been compiled involving people who used the service, with risk assessments in place to protect people. Each person's care needs had been reviewed with them individually each month. Their comments had been recorded and changes made to care plans. This meant that there was a record of people's current care needs.
Where people were unable to make more complex decisions the principles of the Mental Capacity Act 2005 had been followed and decisions made in the person's best interests.
There was a quality monitoring system in place. We saw that changes had been made from comments and suggestions from people using the service, their relatives and staff. The provider sought the views of people to improve the quality of the service.
Is the service caring?
The four people we spoke with told us that they were happy with the care provided. They were positive about the staff and we observed close, warm and friendly interactions between them throughout our inspection. People gave us examples of how staff respected their privacy and dignity. One person told us, "The staff are good. I can talk to my key worker about anything."
A relative told us, "I am very pleased with how they manage X. Staff are very thorough in involving us about progress or when things go wrong. We are always informed."
People told us they made choices about their lives. One person told us, "I sometimes don't want to do certain things. I tell staff if that happens. They may not always agree but they don't press me to do things I don't want to do."
Is the service responsive?
People and their relatives were aware how to make a complaint. A relative told us that they would feel confident in making a complaint and that staff listened to them.
The service responded to suggestions from people who used the service. Meetings with key workers were recorded and we saw that changes had been made as a result of comments that people made. We also saw that actions had been taken where relatives had responded to quality questionnaires and also where comments and suggestions arose from staff meetings, supervision and appraisals. This improved the quality of the service.
Is the service well-led?
Staff were clear about their roles and responsibilities. They said they felt supported by managers and their views were actively sought, they enjoyed their work and felt part of the organisation.
The manager worked alongside other staff on the roster. This meant staff had the opportunity to raise any matters of concern with the manager at any time. We observed open discussions between the manager and staff during our inspection. We saw similar open dialogue that also involved people who used the service. Staff felt confident in their ability to meet people's needs. This ensured that people received a good quality service at all times.
The service has a quality assurance system and records showed that identified problems and opportunities for change were taken and used to continuously improve the service.