The inspection took place on 5 and 6 April 2016 and was unannounced. Pax Hill Residential Home EMF Unit is registered to provide residential care for up to 26 older people who experience dementia. At the time of the inspection there were 19 people living at the service.The service had a registered manager. 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 2008 and associated Regulations about how the service is run.
The provider had completed relevant recruitment checks in relation to staff. However, they had not always ensured that applicants had provided a full employment history or a satisfactory written explanation for any gaps in their employment. Therefore, there was the potential that people might have been placed at risk from the recruitment of unsuitable staff as the provider had not fully assured themselves of their suitability for their role. The provider had not ensured that they had assessed the adequacy of staff’s English language skills. Therefore it could not be established whether staff possessed the required level of competency to be able to communicate effectively with people who experienced dementia.
People and their relatives told us there were enough staff to meet people’s needs. People’s level of dependency was assessed monthly and this information was used to determine the required level of staffing to ensure people’s needs were met safely.
People were safeguarded as staff understood their roles and responsibilities. They had undergone relevant training and had access to written guidance to ensure people’s safety.
People’s relatives told us risks to their loved ones were well managed. Risks to people had been screened, assessed and action was taken by staff to ensure identified risks were managed safely.
Staff who administered people’s medicines had undergone appropriate training. There were processes in place for the safe ordering and disposal of medicines. A staff member was observed not to lock the medicines trolley when administering medicines to people. Although the trolley was always within their sight, there was a potential risk that unauthorised people could have accessed the trolley. This was brought to the attention of the deputy manager who took action to address this with the staff member.
Staff received an induction to their role, training and supervision of their work. The registered manager and the deputy manager had undertaken training in dementia leadership. This enabled them to develop staffs’ practice and improve people’s experience within the service. People received their care from staff who received appropriate support to carry out their role.
Staff had undertaken training on the Mental Capacity Act 2005 and understood the principles of the Act. All of the people accommodated had been assessed as lacking the capacity to consent to their care and treatment at the service. A Deprivation of Liberty Safeguards application had been submitted for each person accommodated as per legal requirements.
People told us they were happy with the food provided and were observed to enjoy their meals. People were offered a variety of nutritious foods and drink across the day which met their dietary needs and preferences.
Staff arranged for people to be seen by a variety of health care professionals as required to maintain their physical and mental health.
People told us staff treated them well. One person told us ”Staff are kind, they treat us properly.” Staff were observed to communicate well with people, using their voice, touch and positioning to facilitate positive communications with people.
People told us staff involved them in making decisions about their care. Staff had access to relevant information about what areas of decision making people were able to participate in and how to support them to make decisions.
People’s privacy and dignity were promoted by staff throughout the course of the inspection. Staff spoke with people politely and with respect. .
People’s families were observed to be able to visit freely. People’s families were encouraged to attend social activities that staff arranged and to celebrate events with their loved ones.
Staff had received relevant training to enable them to support people with their end of life care. People had appropriate care plans to ensure they received the quality care they required.
People’s relatives told us their loved ones needs had been assessed and that they were involved in care planning and reviews of their care. If people experienced behaviours which could challenge staff, then there was written guidance for staff which they were aware of and understood. People’s care was responsive to their needs.
Staff used the information gathered during the care planning process to plan individualised social care for people, which reflected their past occupation and interests. Staff recognised that people needed to be engaged in purposeful activity that had an outcome and meaning for them. Activities reflected the time of year and the seasons to support people to be orientated to the time of year and to stimulate their memory of celebrations and events.
People and their relatives were provided with a copy of the complaints process. Although no written complaints had been received, a person’s relative told us any minor issues they raised verbally were resolved promptly. People’s complaints were listened and responded to.
People appeared to be happy, content and well cared for by staff. Staff were observed to follow the provider’s philosophy of care when meeting people’s needs. There was an open culture, staff’s views were sought and they felt listened to. This enabled staff to feel they could raise issues if they needed to in order to ensure people received good quality care.
People, their relatives and staff told us the service was well managed. The deputy manager was frequently on the floor supporting people and staff. People, their relatives and staff told us the registered manager and the deputy were readily accessible to speak with if they wished.
There were processes in place to enable the registered manager to audit the service for the purpose of identifying any areas for improvement for people. Records demonstrated that when areas for improvement had been identified these had been addressed for people.
People’s relatives told us they had been asked to complete surveys about the quality of the service provided, the results of which were very positive and did not highlight any areas for improvement.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.