The inspection was carried out by one Inspector for over six hours. During this time we met and talked with people who were living in the home, with relatives and with some of the staff on duty. The manager and deputy manager were present throughout the inspection and assisted us in providing documentation for us to view.We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?
Is the service safe?
We found that the company had comprehensive procedures in place to check that people had consented to the care and treatment provided for them. People who lacked the mental capacity to make any specific decisions about where they lived or the care that they needed had been appropriately supported by their family members or advocates, and by health and social care professionals, to make decisions on their behalf and in their best interests. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).
We found that medication management had reliable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained nursing staff.
Staff training records showed that all of the staff had completed mandatory training, which included subjects such as fire awareness, moving and handling, infection control and food safety. Most of the care staff had also carried out training for National Vocational Qualifications/Diplomas levels 2 or 3 in health and social care, or were studying for these. This meant that people were cared for by staff who had sufficient training to enable them to provide safe and effective care.
Is the service effective?
We saw that people had care plans in place which had been discussed and agreed with them. These plans were kept updated, and reflected people's changing needs. They gave the staff clear directions about how to care for each person individually.
We found that the nursing staff referred people appropriately to their GP and other health and social care professionals. This meant that people had the care and treatment that they needed.
Is the service caring?
We talked with people living in the home and with three relatives. All of the people that we talked with spoke highly of the care and treatment given to them by the staff. Some of their comments included: 'It is one hundred per cent good here'; 'It is perfect, I am very happy living here'; and 'Nothing is ever too much trouble for the staff, and they make it really homely.'
We observed that there was a relaxed atmosphere, and saw that people were able to go where they wanted to and do the things they wanted to do. One person said 'There is never any need to get bored in here, there is always plenty to do if you want it!'
We saw that staff treated people with respect and dignity, and showed gentleness and kindness.
Is the service responsive?
We saw that staff were attentive to people's needs, and answered their call bell alarms promptly.
The service carried out residents' meetings, and the minutes from these showed that people's viewpoints were listened to. Changes were made in the home as a result of the discussions.
Care plans showed that the nursing and care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people. This meant that their health needs were being met.
Nurses had different areas of responsibility in the home as well as carrying out general nursing duties. This meant that they were able to keep up to date with specific subjects such as wound care or medication. They provided other nursing staff with information or changes related to those subjects.
Is the service well-led?
The manager had systems in place to provide ongoing monitoring of the home. This included care plan reviews, and checks for the environment, health and safety, staff training needs and medication management.
The manager had an open door policy, and people knew that the manager or deputy manager were always available and willing to talk with them about any specific concerns.
We found that staff had individual supervision meetings on a regular basis, and staff meetings every six to eight weeks. This meant that staff knew that they could raise different ideas and any concerns; and took an active part in working with the management for the ongoing development of the home.
People living in the home and family members were provided with yearly questionnaires. This enabled the management to assess if the home was running well in different areas, and if any changes were indicated that could bring about further improvements.