This inspection visit was carried out on 25 January 2018 and was unannounced. At the last comprehensive inspection on December 2016 the service was rated, 'Requires Improvement.' We found the service was not meeting regulations with regard to providing safe care and having systems in place to ensure quality services. We followed up these issues in a focussed inspection in August 2017 and found improvements had been made, though further improvements were needed to ensure people were always supplied with a safe, quality service. The service remained rated as, 'Requires Improvement.' The service has been rated as 'Requires Improvement' for over two consecutive comprehensive inspections.
At this inspection, we found the provider had continued to make improvements to the care provided. However, some improvements had yet to be embedded into staff working practices to ensure people received consistently good care. The provider had failed to make sufficient, sustainable improvements to the quality of the service. The overall rating for this service remained 'Requires Improvement.'
Vishram Ghar is a 'care home' without nursing. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Vishram Ghar accommodates up to 44 older people across two separate units, each of which have separate facilities. One of the unit specialises in providing assessment, care and support to people who are recovering from a health condition or injury and wish to return to their own homes. The second unit supports older people who require long-term care and support. The service primarily supports people from Asian communities. At the time of our inspection there were 40 people using 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.
Staff had completed training to enable them to recognise signs and symptoms of abuse and felt confident in how to report concerns.
Staff demonstrated a good understanding of actions they needed to take to keep people safe. Records showed potential risks to people had been assessed, but did not always include the detail and guidance regarding the measures staff needed to take to reduce risks. People received the support they needed if they became distressed or were placing themselves and others at risk of harm.
Staff were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures. There were enough staff available to meet people's needs as assessed in their care plans.
People were supported to take their medicines as prescribed. However further improvements were needed to ensure that medicines records were completed accurately and consistently.
Systems were in place to support staff to follow safe infection control procedures to prevent the risk of infection when providing care. Staff were observed not to follow safe procedures when supporting people during meal times.
There were arrangements in place for staff to make sure that action was taken and lessons learned when accidents or incidents occurred, to improve safety across the service.
Staff completed an induction process when they first started working in the service. They received on-going development training and supervision for their role. The registered manager reviewed and evaluated training to ensure it was effective. This supported staff to gain the skills and knowledge they needed to provide care based on current practice.
People did not always receive the consistent support and assistance they needed to enjoy their meals. Where people were at risk of poor nutrition or dehydration, records were not always completed accurately or correctly to show people had received nutrition and fluids in line with their assessed needs.
People were supported to access a range of health professionals to maintain their health and well-being. The service worked in partnership with other agencies to ensure people with complex needs or health conditions had the care and treatment they needed.
At the time of our inspection, the provider was in the process of undertaking work to upgrade areas of the premises. This included décor, replacement of fittings and appropriate signage to support people to find their way around the service independently.
People's needs were assessed before they began to use the service. People were supported to make decisions and choices about their care. Staff understood the principles of the Mental Capacity Act 2005 (MCA), sought consent before providing care and respected people's right to decline care and support.
People were treated with kindness, respect and compassion and they were given emotional support when needed. Staff demonstrated they understood the importance of upholding people's right to privacy and dignity
Staff supported people to express their views and be involved in making decisions about their care as far as possible. This included consulting relatives and access to independent advocates if necessary.
People and their relatives were involved in planning their care and support and were able to make changes to how their care was provided. Care plans were not always updated in a timely manner and records did not consistently provide the detail and information staff needed to meet people's needs. The registered manager had recognised this and work was in progress to review and update all care plans and records.
People were offered a limited range of activities to pursue their hobbies and interests. Staff arranged trips out for people and celebrating events and key festivals. These were met with a positive response. The registered manager was reviewing day-to-day activities to ensure people were provided with sufficient stimulation to meet their needs and wishes.
People's concerns and complaints were listened to and responded to in order to improve the quality of care. People and relatives told us they felt comfortable in raising concerns and complaints and had confidence in the registered manager to take action to resolve them.
There was a registered manager. They were promoting a positive culture in the service that was focussed upon achieving good outcomes for people. They had identified where improvements were required and had taken steps to make changes and develop the service. The provider had systems in place to monitor the quality of the care people received. This included audits of key aspects of the service. We found some audits were not consistently effective in ensure staff followed systems and processes.
People, those important to them and staff were able to share their views the service and the quality of care they received. These were used to critically review the service and drive improvements to develop the service.
You can see what action we told the provider to take at the back of the full report. Full information about CQC’s regulatory response to the concerns found during inspections is added to reports after any representations and appeals have been concluded.