This was a scheduled inspection where we also followed up on one compliance action resulting from an inspection in February 2014. We spoke with 12 of the 36 people at the home. We also spoke with six relatives, the registered manager and staff. We observed care in communal areas and viewed records relating to care, staffing and the management of the home.We considered six outcomes during this inspection. These being
Outcome 2 Consent to care and treatment
Outcome 4 Care and welfare of people who use services
Outcome 8 Cleanliness and infection control
Outcome 14 Supporting workers
Outcome 16 Assessing and monitoring the quality of the service
Outcome 21 Records
We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.
Is the service safe?
We spoke with 12 of the 36 people at the home. They all told us they were happy with the service they received. People said they felt safe. They said they had consistent care staff who knew what support they required. We also spoke with six relatives who were visiting the home. They were also positive about the service and said they felt their relatives were safe. Staff had completed safeguarding and other essential training and were able to tell us what they would do if they had any concerns about people's safety or welfare.
Risks to people's health and safety had been assessed and plans were in place to reduce these risks. We saw specific equipment identified in people's care plans was in place to reduce risks and keep people safe. This included equipment such as pressure reducing mattresses, bed rails and moving and handling equipment. Staff told us they had received training to use equipment and we observed this being used correctly in communal areas. Systems were in use to ensure the home was clean and infection control concerns appropriately managed.
We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards. People's human rights were therefore properly recognised, respected and promoted.
Is the service effective?
Staff were knowledgeable about people's care needs and how to meet them. Staff told us about the care they were providing for specific people which matched information in each person's care plan. Staff had received training to ensure they had the skills necessary to care for people. The registered manager and staff were aware of who to contact for specialist advice and when this may be required. We saw records of when specialists such as community psychiatric nurses and dieticians had been consulted. We spoke with one external health professional who said the home met people's needs well. They said they were 'contacted promptly and appropriately' by the home and their 'guidance was followed'.
We spoke with people and visitors, all of whom were positive about the service provided. Visitors said their relative's health needs were met and they were kept informed when medical professionals had attended. One person told us they were being supported to increase their mobility. We saw they were encouraged to walk as far as they could to the dining room before being assisted in their wheelchair. This showed the care was effective.
Is the service caring?
People were supported by kind and attentive staff. People said they were treated with respect and dignity by all staff. People also told us the staff were very kind and gentle. One person told us 'the carers are lovely people'. Another person said 'The staff are all wonderful, and the quality of care is excellent'. A third person told us 'I like it here'. We spoke with six visitors. One commented 'the staff have been so patient', another said they 'had no concerns about anything'. Similar comments were made by the other visitors.
Staff said they had time to meet people's identified needs and could provide care at times people wanted it. Staff were able to talk about the individual preferences and were aware of peoples life histories. For example, one staff commented a person had worked in the theatre and this was seen in their care plan. Staff were aware of people's rights to refuse care and stated they would respect this. Records of care provided showed people had received care as detailed in their care plans.
Is the service responsive?
The service could be flexible and responsive to people's changing and urgent needs. Discussions with the registered manager showed they were aware of how to get advice and support when required. We saw staff organised an emergency dental appointment for a person during the inspection. Transport and a staff escort were also arranged. This showed the home was able to respond to people's urgent healthcare needs. Following the inspection in February 2014 we made a compliance action as the care plans lacked sufficient individual detail. An action plan was produced and on this inspection we found care plans had all been rewritten and provided appropriate individual detail.
Procedures were in place to manage unexpected events which could interrupt the smooth running of the service. A comprehensive contingency plan was in place which covered all possible emergencies. Staff were aware of the action they should take in an emergency such as when the fire alarms were sounding.
Is the service well-led?
There was a clear management structure with the registered manager being supported by a deputy manager. This meant key management tasks were completed by people with the correct skills to undertake them. One relative said 'the manager is always around and I can talk to him'. There were procedures in place to monitor the quality of service provided with audits, such as for care plans and infection control, being completed. There were regular meetings for people living at the service where issues such as the environment and activities were discussed. Staff meetings were also held enabling staff to raise issues and be kept informed about the service.
Systems were in place to ensure accidents and incidents were managed correctly to safeguard people from repeat incidents. All records requested were available and well maintained. People and relatives had information about how to complain and there were systems to ensure complaints would be investigated by the management team. Staff stated they could rely on the registered manager for support at all times.