Our inspection was conducted over two days. There were 33 people living there when we inspected. We spoke with 14 and five relatives about their experiences. We also spoke with four staff, the newly appointed manager and the deputy manager. Some people had limited verbal communication skills so we observed their interactions with staff and their body language to understand their experiences. Below is a summary of what we found. We used all the information to answer the five questions that we always ask
Is the service safe?
We saw that the people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to them. Some care plans did not reflect the level of care that was being given because reviews and checks had not identified gaps such the lack of risk assessments for specific health conditions or out of date pain management systems. This meant that staff did not always have the information they needed to meet people's needs safely.
Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.
We saw that people generally received good and safe care and the majority of the relatives spoken with told us that they were happy with the care provided. The relative of one person said, 'They are brilliant here, staff are very caring. Mum's safe and loved here.' However one relative did say, 'If I had any complaint it would be that my relative waits too long for staff to assist her in using the toilet and, at times I had to ask staff for their help.'
CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes and hospitals. No applications to restrict anyone's liberty had been made. The majority of staff had received Mental Capacity Act 2005 and DOLS training and understood their role in protecting people's rights.
We saw in some care plans that assessments of people's mental capacity were needed along with reviews of their advanced instructions for emergency medical situations. This meant that the manager and staff understood how this legislation applied to people and protected their rights but that people's safety wasn't protected in an emergency because updates and reviews planned for had not taken place.
All staff had been given the knowledge and information to be able to be alert to the signs of, or potential for abuse of vulnerable adults. All people spoken with told us that they were safe in the home. However, we found that people were not fully protected from the risk of abuse, because staff had failed to recognise and record unexplained bruises and scratches and ensure that they were adequately investigated. The manager had not appropriately reported all important events that affected people's welfare, health and safety to us and act on incidents that were classified as safeguarding. This meant that the provider had not taken action to fully protect people.
We saw that the systems that were in place to make sure that learning took place following accidents, incidents, complaints and investigations were not sufficiently robust to protect the safety and welfare of the people who lived there. Some staff spoken with were not aware of the providers reporting system.
We looked at the management of medicines and raised a number of concerns with the management team about the administration of some medicines. We found that the home did not have a system to record where the analgesic patches had been applied to the body, and that instructions to administer some medicine prescribed with specific administration times had not been adhered to. This meant that people did not always receive their medication as prescribed by their GP to protect their health and wellbeing.
Is the service effective?
People's care and health needs were assessed and planned in a personalised way. We saw that people's changing needs were not always monitored and care and support appropriately adjusted. This meant that people's care was planned but not always delivered in line with their individual needs.
We saw that people weight was recorded regularly. This is important as a significant loss or gain of weight could be an indicator of an underlying health need. Referrals had been made to external professionals so that people got the support they needed to maintain their health and wellbeing and we saw that staff followed their advice.
We saw that information was displayed about activities that were planned for. We also saw that residents meetings took place regularly and people who lived here were involved in menu planning and choices for entertainment and activities. Some people told us that they enjoyed the activities that took place. One person told us, 'I enjoyed the barbeque. We have a lot of fun here.' This meant that group activities were planned for and took place.
Is the service caring?
Some staff spoke with people in a tone that expressed friendship and support and offered people choices throughout the day whilst other staff were observed to ignore the presence of residents and failed to engage in conversation with them when they delivered care or gave support with meals. Some staff told us that they felt there weren't sufficient staff to support people who had dementia with all of their needs.
Most people we spoke with told us they were happy and the carers were nice and worked hard. One person said, 'I am very happy here. It's beautiful and we do lots of things. The staff are so kind. Nothing is too much trouble.'
Is the service responsive?
We saw that there was a system to review people's care plans and risk assessments on a regular basis to ensure that their changing needs were planned for. However these reviews did not always identify peoples changed needs so that staff appropriately adjusted their care and support.
We saw that actions were taken to protect people's health as needed. We saw that staff acted on peoples deteriorating health and liaised with doctors and other professionals regularly. One relative said, 'Any concerns are dealt with straight away. They are great and always keep me informed about mum.' This showed that the service was responsive and kept relatives informed about people's health.
We observed that some staff responded to some people's needs in a caring and appropriate way. However, people told us and we observed that care was not always delivered in a timely manner to all people. We also observed that people who were nursed in bed on the upper floor spent long periods of time without the stimulation of conversation or activity. Some people did not have call bells close at hand. This meant that some people did not have their health and well-being promoted and protected by interactions or social activities.
Is the service well led?
The manager at the home is newly appointed and we have not registered them to be responsible and competent to manage the home. The registered provider was reminded of their legal obligation to have a registered manager in place in compliance with their registration requirements.
People were consulted about the quality of service they received. Comments and suggestions were analysed to identify where improvements were needed.
Whilst people and relatives spoken with had few or no concerns about the service they received. We found that effective systems were not in place to monitor the quality of the service. This has led to shortfalls in a number of the regulations that we assessed.
We saw that some care records and medication administration records lacked relevant, up to date information. This meant that people may not always receive safe and effective care that met their needs. We saw that confidential information about people's care was in the main kept securely.