In this report the name Vanessa Russell 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 identified as the registered manager on our register at the time.The local authority and other external health care agencies had concerns regarding the care and welfare of some people who lived there. Concerns raised included, the number of falls people experienced, inadequate record keeping and dementia care. As a result the local authority suspended the funding of new placements. The local authority then determined a gradual improvement had been made and the suspension had been partially lifted to allow the provider to admit one new person per week to the home. However, during the week of our inspection new issues had been raised regarding a high number of people who had allegedly suffered from urinary tract infections and some aspects of infection prevention . External health care professionals had started to investigate those issues to determine whether or not there was a concern. Due to this the local authority was again reassessing if a suspension of new placements was required.
This was our first inspection of this home under the ownership of the present provider. The home environment comprised of three floors where people lived and were cared for. At the time of our inspection 60 people lived at Hall Green. (This included 18 people who required rehabilitative care and support). This provision was available for a short duration as ultimately people could return back to their homes within the community or transfer to an alternative care facility.
During our inspection we spoke with ten people who lived there, five relatives, nine staff and the manager. The majority of people who lived there and their relatives were positive about the home and the services provided. One relative said, 'They are well looked after. I have no concerns'. One person who lived there said, 'I like living here'. Comments from other people included, 'I'm happy' and, 'I like it here' However, a number of people and relatives told us to us that some aspects needed some improvement which included activity provision, the cleanliness and staffing levels.
We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
People told us they felt safe. All people and relatives that we asked told us that they had not seen anything of concern. One person told us, 'The staff have never done anything to me that I do not like'.
Staff we spoke with knew of Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. At least two DoLS applications had been approved by the local authority and were being reviewed. This showed that systems were in place to keep people safe.
We found that people's mobility needs had been assessed and were generally met. However, the management of day to day risks and safety should be improved upon. Those include systems to prevent falls, dehydration and malnutrition.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping people safe.
Is the service effective?
People's health and care needs were assessed but they were not always included in detail in their care plans. For example, care plans did not highlight what action staff should take to reduce people who suffered from agitation. This meant that care plans were not able to consistently support staff to meet people's needs.
Systems in place did not give assurance that when staff identified that people had red skin adequate action or care planning was effective to prevent skin breakdown.
Systems regarding menu planning and the main mealtime experience process were not effective. Although a number of people told us that the meals were good, other people told us that they were not. Some people told us that meals lacked variety.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care planning and meal time experiences to ensure that the service is effective.
Is the service caring?
Overall we determined that staff showed people respect and promoted their dignity. We saw that staff showed patience when supporting people. A relative said, 'The staff are good'. The majority of people we spoke with told us that the staff were caring and kind.
We found that day to day activity provision was lacking. A number of people told us that they were bored. One person said, "There is not much to do". A relative told us, "There are not enough activities. People are always asleep in their chairs".
People who lived there and their relatives had not been given the opportunity to complete satisfaction surveys. The registered manager told us that they were in the processes of addressing this. By listening to the views of the people who live there and their relatives the provider would know where improvement was needed.
We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that the service provided was caring.
Is the service responsive?
The provider had acknowledged that fall prevention systems should be improved and was to have a new alarm system installed. This demonstrated some responsiveness.
During this inspection we found non-compliance in a number of areas. Most non-compliance had already been raised with the provider by external care agencies. The provider had made some changes but improvement was slow/or there had been no improvement. This did not give assurance that the service had been adequately responsive.
People and their relatives told us that they were concerned about odour and the cleanliness in some parts of the premises and some soft furnishings. Our observations confirmed those concerns. A relative said, "The chairs and carpet are filthy. It is disgusting". We saw that the issues had been raised in senior manager visit reports from at least January 2014 yet there was no replacement of the carpets and soft furnishings. This did not give assurance that the provider had been adequately responsive.
We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make to ensure that the service is responsive.
Is the service well-led?
The provider told us that improvements had been made since external care agencies had raised issues. However, our observations showed that staff did not always perform to the standard that was required when using the hoist or by paying adequate attention to people's needs at mealtimes.
The provider had basic quality assurance systems. However, records seen by us showed that they were not all completed adequately and some care plans relating to dementia care, skin damage and those to evidence sufficient food and fluid intake were not adequate. This showed that staff not undertaken tasks as they should and did not give assurance that the service was well led.
We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make in relation to the management of staff and quality assurance processes to demonstrate a well led service.