In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still Registered Manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.Two adult social care inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? We undertook this inspection because concerns had been raised with us by relatives and professionals about the quality of support being provided. The concerns primarily related to managing people's finances, poor practice going unaddressed by managers, staffing levels and a lack of staff experience and knowledge.
We used a number of different methods to help us understand the experiences of people using the service because some people using the service had complex needs which meant they were not always able to tell us their experiences. As part of this inspection we spoke with five people who use the service, five relatives, five senior staff, seven care staff and three health and social care professionals. We also observed support being provided to three further people and reviewed records which included five care plans, daily care records, staff training records and relevant policies and procedures. Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
Is the service safe?
People were kept safe from abuse because staff knew what to do if they became aware abuse was taking place. Information was shared with the correct agencies in a timely fashion and action was taken by the service. The system in place to safeguard people's money had recently been improved following allegations of financial abuse.
Risk assessments were in place for each person and had been used to inform people's support plans. These risk assessments balanced the need to keep people safe with the person's right to make choices and be as independent as possible. Staff were able to provide safe care that reflected people's needs as the support plans accurately recorded the needs and preferences of each person.
Although there were enough staff on duty during our inspection to provide safe care, we were told by relatives and professionals that low staffing levels sometimes prevented people being able to have individual time with staff or go out as much as they may want to.
Is the service caring?
Each person's care plan identified how involved they had been in the care planning process. People were being supported to take part in meetings to plan their care. This allowed them to tell staff what was working well for them and what was not. It also allowed them to set outcomes they wanted to work towards.
The support we observed was provided by staff who were patient and kind. We received positive feedback from some relatives about the support currently being provided. Some negative feedback was also received and has been shared with the provider for investigation.
Is the service responsive?
People were asked for their views on the quality of care. A survey had been completed in 2012 and a review of the responses had resulted in action being taken by the provider. We were told by most relatives they felt listened to and that their concerns were addressed.
Is the service effective?
We saw health action plans that monitored people's health needs. These documents helped staff ensure people stayed well. The training needs of staff were monitored to ensure they had the training they needed to support people safely. Some professionals visiting the service told us staff had the knowledge they needed to meet people's immediate needs but sometimes lacked an understanding of wider health and social issues affecting the person. This could result if people not receiving the most appropriate support.
Is the service well-led?
The level of oversight and support provided for staff had recently been increased. We received positive feedback from staff, professionals and relatives regarding these changes. There had also been an increase in the quality monitoring taking place. This had resulted in poor practice being challenged and ongoing problems being addressed.