The inspection took place on 24 August 2015 and was unannounced.
The home provides residential care for up to 39 people who require care due to old age, living with dementia or mental health needs. It is located in the countryside four miles north of Sleaford in Lincolnshire. On the day of our inspection there were 34 people living at the home.
We carried out an unannounced comprehensive inspection of this service on 19 November 2014. Breaches of legal requirements were found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to safeguarding service users from harm, ensuring people received care which met their needs, providing appropriate numbers of staff with the correct skills and support to meet people’s needs, managing medicines safely, meeting people’s nutritional needs and ensuring that they gathered people’s views on the service and had effective systems to assess the quality of service provision.
There was a registered manager for the service, however, they no longer worked for the provider and a new manager was in post. The new manager had submitted an application to register with the Care Quality Commission and we asked the provider to request the registered manager cancel their registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At our inspection on 24 August 2015 the provider had taken all the actions necessary to meet the legal requirements in the areas where they had breached regulations. However, time was needed to see if the systems would continue to support good quality care over time. In addition, further improvements were needed to provide person centred care which met people’s individual needs.
We saw the provider had appropriate assessments to identify where people were at risk while receiving care. Care was planned and equipment used to reduce the level of risk and keep people safe. In addition, accident and incidents had been reviewed and changes made to people’s care to prevent similar occurrences in the future. Medicines were stored and administered to people safely. However, records did not contain information needed to provide person centred support to people and medication records did not contain information about the creams people needed applying.
Staff received ongoing training which supported them to have the skills needed to care for people safely. However, staff did not always provide care according to the training they had received. Training in how to keep people safe from harm had been effective and staff knew how to raise concerns to external agencies. The manager had worked collaboratively with the local safeguarding authority to ensure people were safe from harm.
The manager had calculated the number of care workers needed to meet people’s needs and had used this information to develop rotas which included more staff at busy periods of the day. However, at times the home was not fully staffed due to sickness and this impacted on the care people received.
People were supported to have access to hot and cold drinks and appropriate equipment was provided to support them to remain independent with drinking. Staff and the cook were knowledgeable about people’s nutritional needs and ensured appropriate food was available. People had a choice of meals but could also request food not on the menu.
The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect
themselves. The registered manager was aware of their responsibilities under the Mental Capacity Act 2005. However, information on DoLS was not always recorded in people’s care files.
There was a warm and caring relationship between staff and people who lived at the home and people were supported to be involved in planning their care. Staff respected people’s privacy. However, at times people had not been supported with their dignity.
Care plans had been regularly reviewed and contained information needed to provide safe care. However, they did not always support staff to provide person centred care. There was some activities provided in the home which some people chose to join in. However, some people told us the activities did not suit their needs or support them to maintain their hobbies. The provider had recognised the need to improve activities and was working with an outside agency to improve they type of activities offered.
The manager was available and approachable and people living at the home, visitors and staff were happy to raise concerns and were confident that they would be resolved. The provider had responded to complaints in an open and transparent manner which showed they were aware of their legal responsibility to be honest with people using the service.
People living at the home, visitors, healthcare professionals and staff had been consulted about their views of the home and the manager had taken account of their views to improve the quality of care provided. There was a series of audits in place to monitor the risks to the service and quality of service provided. The manager had taken action such as informing staff of issues and providing extra training when the audits had identified concerns.