At the last inspection on 13 and 14 January 2015 we found a breach in regulations which related to infection prevention and control. The overall rating for the service was, “Requires improvement”.
Following the inspection in January 2015 we received an action plan from the registered provider detailing how improvements would be made including a timescale. At this inspection we found some improvements had been made, however we identified continued and further breaches in regulations.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was not present during our inspection. The deputy manager had been appointed to the role of acting manager in May 2015 and was present throughout the inspection.
This inspection was unannounced and took place on 2 and 7 September 2015.
Although we found some improvements had been made in regard to standards of hygiene and cleanliness, these were not comprehensive and significant shortfalls were identified. Many areas of the environment and furnishings still required redecoration and renewal. There was no formal maintenance programme in place.
We found there were insufficient staff at times during the day to meet the needs of people who used the service. Some people’s needs had changed and their needs were more complex. Staffing levels had not kept pace with this.
Care plans were person centred but we found evidence they had not always been updated following changes in people’s needs. Staff had not maintained accurate and detailed supplementary records to monitor people’s fluid and food intake and repositioning support.
The quality of the service had not been monitored effectively and shortfalls had not been dealt with or had not been identified. There was a lack of established quality assurance processes to ensure continuous improvement.
The above areas breached regulations in cleanliness and infection control, staffing, care records, premises/equipment and monitoring the quality of the service. You can see what action we told the registered provider to take at the back of the full version of the report.
We found the staff recruitment and selection procedures were robust which helped to ensure people were cared for by staff who were suitable to work in the caring profession. In addition, all the staff we spoke with were aware of signs and symptoms which may indicate people were possibly being abused and the action they needed to take.
Staff had access to training relevant to their roles. Delays with the provision of some training courses were being followed up by the acting manager.
We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GP’s, hospital consultants, community mental health nurses, opticians, chiropodists and dentists. People received their medicines as prescribed and medicines were held securely.
Staff supported people to make their own decisions and choices where possible about the care they received. When people were unable to make their own decisions staff mostly followed the correct procedures and involved relatives and other professionals when important decisions about care had to be made.
People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. Arrangements at lunchtime to provide one main meal and only offer alternatives if people didn’t eat this, could limit some people’s choices.
Although some improvements had been made with activities, staff often struggled to find time to do these due to other work pressures.
There were positive comments from people who used the service and their relatives about the staff team and the approach they used when supporting people. Staff respected people’s privacy and dignity.
There were systems in place to manage complaints and people who used the service and their relatives told us they felt able to raise concerns and complaints.