We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; ' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found-
Is the service caring?
We spoke with three people who told us that their needs were met. One person told us, 'My drinks have thickener in them. The staff do this for me. They always get it right.' Another person said, 'The staff help me in the hoist. There is always two of them. I feel very safe when they help me.' A further person commented, 'The staff help me in the hoist as I can't walk. I feel safe in it.'
Is the service responsive?
People could access healthcare service when they required. One person told us, 'I don't see the doctor very often, but I can see him when I want.' We found that contact and advice from healthcare professionals such as the GP and speech and language therapist were detailed in people's care records. For example, a GP had been contacted and prescribed medicine for a chest infection.
We spoke with three people who were aware of the complaints system and felt able to make complaints. One person told us, 'I would feel able to complain if I needed to. I could speak to any of the staff.' Another person said, 'I have no complaints at all. I would tell the matron if I did.' The registered manager told us that each person had been given a copy of the home's complaint's procedure. We looked at meeting minutes which showed that the complaints procedure had been discussed with people and their representatives.
The home's complaints procedure provided information as to how people could make complaints. The procedure detailed who the complainant should contact and what to do if they were not satisfied with the response. The provider may find it useful to note that the complaints information stated that complaints should be referred to the Care Quality Commission (CQC) if either party was not satisfied with the local process. The CQC does not have powers to investigate individual complaints but can be contacted at any time for people to share their experience of care services which helps to inform how we inspect.
Is the service safe?
Care was not always planned and delivered to meet people's needs. For example, there was not an effective system in place in relation to the changing of people's urinary catheters. The registered manager told us that three people living at the home had a long term urinary catheter. There was no plan or system in place to highlight when people's urinary catheters would be changed. One person's urinary catheter had not been changed at the time it should have been. The registered manager told us that they would arrange for this person's catheter to be changed immediately.
Care was planned and delivered to reduce the risk of people falling and developing pressure related skin damage. For example, one person had been assessed as being at a high risk of skin damage. We found that a plan was in place to reduce this risk which included them being assisted to change position at regular intervals and to have a pressure-reliving air-mattress. We saw that this equipment was in place and was set to a level consistent with the person's weight. We looked at records which demonstrated that this person was assisted to change position regularly. Another person was assessed as being at risk of falling from bed. There was a plan for this person to have bed rails and bumpers attached to their bed to reduce this risk. We found that this equipment was in place.
We found that the home was clean and smelt fresh. We spoke with three people. One person told us, 'The home is absolutely spotless. They are forever cleaning it. The bathroom and toilet are done every day.' Another person said, 'It's always very clean here. They do the hovering and I polish.' A further person commented, 'It's very clean.' The home had a team of housekeeping staff. We spoke with the head house keeper who told us that they considered that the arrangements for cleaning were sufficient to keep the home clean.
No one living at the home was subject to an authorisation under the Deprivation of Liberty Safeguards. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely. The registered manager told us that they were in the process of reviewing the impact of a recent Supreme Court judgement which may affect some people living in care homes.
Is the service effective?
Our inspection on 30 October 2013 found that not all staff were appropriately supported in relation to their responsibilities because they did not all receive appropriate supervision to enable them to deliver care and treatment safely and to the appropriate standard. The provider wrote to us and told us that they would make changes to meet the requirements of this standard. During this inspection we found that improvements had been made.
We spoke with three people who told us that they were supported by skilled staff. One person told us, 'I am confident that they know what they are doing. It's very reassuring being in a place like this. They have to do a lot for me.' Another person said, 'All of the staff are very good.' A further person commented, 'The day staff are very good.'
Staff considered that they had sufficient training to carry out their roles effectively. We spoke with five staff who had different positions within the home. Staff told us they had completed training in a variety of topics such as, health and safety and moving and handling. Staff told us that they considered that the training they had received had been useful to complete their duties. We looked at the training records. We found that not all staff had attended training in topics such as fire and moving and handling. For example, we found that seven of the 26 healthcare care assistants had not completed fire training. The registered manager told us that training was being carried out at the time of inspection which would reduce this number.
Staff were supervised and supported. The registered manager had introduced a new system of staff supervision. We found that all staff were allocated a supervisor. Staff told us that they had received supervision within the last two months and had found this useful and supportive. Staff told us that during supervision sessions they were able to raise concerns and receive feedback as to their performance.
Is the service well led?
People's views of the service were sought. The provider sought the views of people using a variety of methods. For example, we found that a survey of people and their representatives had been carried out. The results of this survey were analysed and an action plan developed to address issues raised in the survey. The results of the survey and plans were presented to a meeting of people and their representatives.
Staff views were sought. We spoke with five staff who told us that they felt able to make suggestions to improve the service. The provider undertook a survey of staff views and had developed an action plan to address issues raised by staff.
The provider undertook a variety of audits of practice. Audits included, staff hand hygiene, infection rates, medicines and health and safety. There was a monthly review of accidents and incidents. The registered manager told us that they reviewed the supervisions of staff on a regular basis to ensure that staff were supported.