We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to look at the overall quality of the service. This inspection took place over two days on 29 August and 2 September 2014 and was unannounced.Before the inspection we looked at information we held about this service, such as notifications and monitoring reports undertaken by the local authority.
During the inspection we spoke with three people who used the service, three visitors and a National Vocational Qualification (NVQ) Assessor. We also spoke with the provider and seven staff working in the home; the person in charge, two care staff, the clinical nurse lead, activities coordinator, the cook and the handyperson. We checked the environment for safety, hygiene and cleanliness and looked at policies, care plans and other records.
The registered manager was on holiday when we visited. After the inspection we asked them for feedback on the improvements they were making in relation to infection control. The registered manager provided the information requested.
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 safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well led?
Is the service safe?
Care plans provided evidence of good risk management. For example, information in records provided evidence of staff taking prompt action to make referrals when they identified concerns relating to people's health and welfare.
Environmental risks had been assessed and the home's equipment had been subject to servicing and maintenance at regular intervals.
An application had been made for authorisation to restrict a person's liberty in order to protect them from accidental harm. The application was made appropriately under the Deprivation of Liberty Safeguards.
The registered manager had developed an action plan for making improvements to infection control systems in the home. This was in response to recommendations made following an infection control audit of the home in May 2014.
Seven staff told us they were confident that they had sufficient training and support to develop the knowledge and skills needed to safely care for and support people living in the home.
Auditing of the medication administration system had ensured that errors and omissions were identified and corrected.
Is the service effective?
The service was not always effective. Three relatives and a person living in the home confirmed that they had been consulted and contributed to developing care plans, although we found no evidence of this having been recorded in care plans.
Care plans did not contain evidence of capacity assessments to ensure that actions in care plans were being taken in the best interests of people who used this service. Consequently there was no evidence to show if decisions taken by staff complied with MCA guidance on best interest decision protocols.
Care plans and risk assessments had been kept up to date and people living in the home had been referred for professional advice when healthcare concerns had been identified.
Three relatives told us they were always made welcome when they visited and that there were no restrictions placed on visiting times. This enabled people living in the home to maintain and develop their relationships with family and friends.
Systems for dealing with complaints, suggestions and compliments made sure that the views of people using the service and their representatives were responded to by making improvements where appropriate.
People living in the home had access to a range of daily activities, which provided them with stimulation and interest.
Is the service caring?
Three relatives and a person living in the home confirmed that staff always treated people in a respectful and dignified manner. A relative said, "I visit most days and can honestly say that all the staff respect people's privacy and dignity.'
During both our visits to this home we observed care and nursing staff use good observational skills to provide person-centred and compassionate care. A person living in the home told us, 'It's really good here. They look after us very well."
A senior member of staff told us they spent time sitting and talking to relatives when they visited, to ask their views on the quality of the service. This was confirmed in our conversation with three relatives.
During the midday meal we observed interactions between care staff, nurses and the people they cared for. We saw care staff use good observational skills to provide person-centred and compassionate care. Staff addressed people by their preferred titles and spoke with them in a quiet and calming manner to preserve their privacy and dignity.
Is the service responsive?
People living in the home had their needs assessed and their care plans showed how staff would provide care and support to meet their needs. The people we spoke with during our visit made positive comments about the way the service was provided. They said they were listened to and consulted about the care and support they received.
The registered manager and provider had taken responsive action to make improvements to the service. They gave us examples of the changes they had made in response to recommendations made by the NHS Infection Control Nurse and local authority contract monitoring. This demonstrated that the provider was responding by making improvements to the quality of the service being provided.
Is the service well-led?
The registered manager had implemented quality assurance processes to protect people living in the home from accidental injury, medication errors and the risks associated with providing care and treatment.
The people we spoke with during our visit told us the home was managed well. A visiting National Vocational Qualification (NVQ) assessor said, "This is one of the better homes. The staff are well trained and the home is well run. Staff receive good support to achieve their NVQ qualifications."
Staff working in the home told us, "The manager is fair, approachable and firm. Things get done and it's a really good home to work in. We work well as a team."