The inspection was carried out by one Inspector over seven hours; and by a Pharmacy Inspector who stayed for three hours and assessed the management of medicines. We followed up outcomes in the home which had been identified as concerns during the previous inspection; and looked at some additional outcomes.During the visit we talked with six people who were living in the home, and observed staff carrying out care duties. We talked with eleven staff and met other staff briefly; and talked with one relative, four visitors, and a visiting health professional. We also talked with a student nurse who was on a work placement in the home. The manager and deputy manager were present throughout the inspection and assisted us by providing documentation for us to view.
We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?
Is the service safe?
We saw that the premises were visibly clean in all areas and were satisfactorily maintained. A new wing had been built, and was sectioned off until it had been registered for use. This was to prevent people from wandering into this area where staff were not present.
We inspected medication management and found that appropriate procedures were in place to ensure that people received the right medicines at the right time, with the support of trained nursing staff.
We found that the company had comprehensive procedures in place to check that people had consented to the care and treatment provided for them. People who lacked the mental capacity to make decisions about where they lived or the care that they needed had been appropriately supported by their family members or advocates, and by health and social care professionals, to make decisions on their behalf and in their best interests. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that people were appropriately supported according to their levels of mental capacity.
Is the service effective?
We found that people's care plans provided clear details of their care and treatment so that staff could give effective care. The care plans included individual needs assessments, and people's preferences in regards to their care. We saw that people or their representatives had been involved in all aspects of their care planning.
We found that the staff liaised appropriately with other health and social care professionals to provide people with additional care or treatment.
The home provided people with a variety of food and drinks to meet their different nutritional needs. People said that the food was good, and they could choose alternatives to the two main dishes provided each day if they preferred something different.
Staff had been trained in required subjects such as health and safety, moving and handling, infection control and safeguarding vulnerable adults. We saw that this training was kept up to date, and additional training courses were provided so that staff could develop their skills and their knowledge in line with people's needs.
Is the service caring?
We saw that the home had a relaxed atmosphere, and people were supported to sit where they wanted to, and to take part in activities that they preferred. People's comments included, 'The staff look after me extremely well. Everyone is very nice and friendly'; and 'I think it is excellent here, staff are very caring.'
The home provided a range of activities. We saw that these were carried on throughout the day, and included individual time with staff, and group activities. People were enabled to go out for walks, or sit in the lounges or the gardens; or could sit in their own rooms, depending on their choice. Activities were sometimes carried out during the evenings as well.
We saw that some people needed assistance with eating and drinking. The staff sat alongside people and engaged them in conversation during this time, so as to make the meal a more pleasant experience. We saw that staff did not rush people.
We viewed responses that people had given to questions in the last survey, which had been carried out by the home to assess people's experiences. One of the questions was 'Do staff treat you with respect and dignity?', to which one hundred per cent of people had responded 'Yes.'
Is the service responsive?
The service had an arrangement with the local GP surgery for routine weekly visits to the home. We saw that nursing staff recognised when people needed to see the doctor and ensured they were seen as needed. Referrals were made to other health and social care professionals as necessary.
Care staff and activities staff were aware of people who were bed bound and needed to stay in their rooms. They carried out a minimum of hourly checks during the day and the night to ensure people had the care that they needed. We found that staff spent individual time with people in their own rooms in order to prevent social isolation.
People that we talked with said that if they had any worries or concerns they would talk to any of the staff. They were confident that the staff would take appropriate action to deal with their concerns, or would speak to the nurses or the manager or deputy manager to ensure the necessary action was taken.
Is the service well-led?
The company had systems in place for the on-going monitoring of the home. This included weekly and monthly audits for different aspects of care in the home such as care planning audits and medication audits. Other audits for the environment were carried out, such as health and safety checks, fire system checks and recording of water temperatures.
We saw that the manager and deputy manager had a visible presence in the home, and people knew them well. Staff said that they found the management structure to be supportive; and some staff members said they knew some of the senior managers in the company, and could talk to them if they wanted further advice.
We found that people's comments on surveys were followed up where action was needed. Staff said that they felt able to raise concerns and they were listened to. For example, staff said they would be able to discuss the implications of having six extra beds which were soon due to be registered, as this could mean some changes in staffing numbers and deployment.