We spoke with seven of the 32 people at the home. We also spoke with five relatives, the registered manager and staff. We observed care in communal areas and viewed records relating to care, staffing and the management of the home.We considered seven outcomes during this inspection. These being
Outcome 2 Consent to care and treatment
Outcome 4 Care and welfare of people who use services
Outcome 8 Cleanliness and infection control
Outcome 10 Safety and suitability of the premises
Outcome 14 Supporting workers
Outcome 16 Assessing and monitoring the quality of the service
Outcome 20 Notification of other incidents
We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.
Is the service safe?
People told us they were happy with the service they received. They said they had consistent care staff who knew what support they required. We also spoke with five relatives. They were also positive about the service and said they felt their relatives were safe. Staff had completed safeguarding and other essential training and were able to tell us what they would do if they had any concerns about people's safety or welfare.
Risks to people's health and safety had been assessed and plans were in place to reduce these risks. We saw specific equipment identified in people's care plans was in place to reduce risks and keep people safe. This included equipment such as pressure mattresses and moving and handling equipment. Staff told us they had received training to use equipment and we observed this being used correctly in communal areas. Systems were in use to ensure the home was clean and infection control concerns appropriately managed.
The home was meeting the requirements of the Deprivation of Liberty Safeguards. People's human rights were therefore properly recognised, respected and promoted.
Is the service effective?
Staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills necessary to care for people. Staff told us about the care they were providing for specific people which matched information in the person's care plan. The registered manager and staff were aware of who to contact for specialist advice and when this may be required. We spoke with two external health professionals who said the home met people's needs well. We found there were arrangements to meet the wound care needs of people. We saw where two people had been admitted with extensive pressure injuries, the home had sought advice from the tissue viability nurse and these wounds were either healed or improving. This showed the treatment was effective.
We spoke with people who used the service and visitors, all of whom were positive about the service provided. Visitors said their relative's health needs were met and they were kept informed when medical professionals had attended.
Is the service caring?
People were supported by kind and attentive staff. People said they were treated with respect and dignity by the nursing and care staff. People also told us the staff were very kind and gentle. One person told us 'I was really anxious when the hospital said I needed a nursing home however, it's wonderful here and I would recommend it to anyone'. Another person said 'The staff are all nice'. A third person told us 'I've been in before for respite and it's so nice I wasn't worried when I had to come back'. We spoke with five visitors. One commented their relative 'always looks clean and looked after, clean clothes, clean sheets and the home never smells', another said, 'I didn't want (my relative) to come into a nursing home but the staff here have been wonderful, very impressed'. A third said their relative had been at the home several years and they 'had no concerns about anything'. Similar comments were made by the other visitors.
Staff said they had time to meet people's identified needs and could provide care at times people wanted it. Staff were able to talk about the individual preferences of people such as favourite television programmes or type of music. Staff told us how they had learnt a few words of a foreign language to support a person whose first language was not English. Staff were aware of people's rights to refuse care and stated they would respect this. Records of care provided showed people had received care as detailed in their care plans.
Is the service responsive?
The service could be flexible and responsive to people's changing and urgent needs. Discussions with the registered manager showed they were aware of how to get advice and support when required. We saw additional staff could be made available at short notice when an off duty nurse was contacted to work on the day of the unannounced inspection to release the registered manager from a nursing shift.
Procedures were in place to manage unexpected events which could interrupt the smooth running of the service. A comprehensive contingency plan was in place which covered all possible emergencies. We were told how the service had managed when the lift had been unavailable due to planned maintenance for three weeks in 2013. People who regularly spent time in the ground floor communal rooms were moved to ground floor bedrooms and activities staff had provided additional activities on the first floor.
Is the service well-led?
There was a clear management structure with the registered manager having lead role for nursing and care and the business manager having the remaining management responsibilities. An administrator was also employed with specific responsibilities. This meant key management tasks were completed by people with the correct skills to undertake them. There were procedures in place to monitor the quality of service provided with audits, such as for care plans and infection control, being completed.
A survey of the views of people, visitors and external professionals had been completed in May 2013. This had shown people and external professionals were satisfied with the service provided. This also showed there had been an increase in respondent's satisfaction with the service from the previous survey. Systems were in place to ensure accidents and incidents were managed correctly to safeguard people from repeat incidents. People and relatives had information about how to complain and there were systems to ensure complaints would be investigated by the management team. Staff stated they could rely on the registered manager for support at all times.
We identified that we had not been notified about all incidents which the registered person was required to inform us about.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring we are informed about all notifiable incidents.