Archived: 8 Graeme Close

There was a registered manager in post. 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.

At our last inspection in October 2016 we rated the service overall Good. At that inspection we found one breach of Regulations 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found that notifications to the commission were not always made when required and in line with our legislation.

Following the inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of that regulation. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. In addition they had sustained previous good practice. As a result of this inspection the service remains with an overall rating of Good.

Why the service is rated Good.

The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, action plans were in place about how to manage these, monitor and review them. Medicines were managed safely and staff followed the services policy and procedures.

People were supported by the services recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

People moved into the service only when a full assessment had been completed and the registered manager was sure they could fully meet a person’s needs. People’s needs were assessed, monitored and evaluated. This ensured information and care records were up to date and reflected the support people wanted and required.

Staff had the knowledge and skills they needed to carry out their roles effectively. They were supported by the provider and the registered manager at all times. People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty safeguards (DoLS) were understood by staff and, appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People received a varied nutritious diet, suited to individual preferences and requirements. Mealtimes were flexible and taken in a setting where people chose. Staff took prompt action when people required access to community services and expert treatment or advice.

People were confident in their surroundings and with each other. The atmosphere was very pleasant and people were doing their own things to relax and pass the time of day. The home had a family atmosphere and homely feel. Staff were knowledgeable about everyone they supported and it was evident they had built up relationships based on trust and respect for each other. People experienced a lifestyle that met their individual expectations, capacity and preferences. There was an ethos of empowering people wherever possible and providing facilities where independence would be encouraged and celebrated.

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People were involved throughout these processes. This ensured their needs were clearly identified and the support they received was meaningful and personalised. Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals and where necessary care and support had been changed to accurately reflect people's needs.

The service provides nursing care and accommodation for up to 16 people with mental health needs. At the time of our inspection, 15 people were living in the home although two were in hospital.

There was a registered manager in place at the home. 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.

People and their relatives told us they were happy with the care provided by the home. We received a number of positive comments about staff including "marvellous" and they "give very good care". Our observations showed that staff were kind and respectful.

Care was planned in a person centred manner that took account of people's individual preferences and wishes. For example, people's preferred daily routines were described and we saw from daily records that these preferences were supported by staff. People were able to take part in a range of activities if they wished to.

People in the home were safe. There were sufficient numbers of staff to ensure their needs were met. Staff vacancies were managed so that the impact on people was minimised through the use of regular bank and agency staff. Staff received training and supervision to support them in carrying out their roles effectively.

People's rights were protected in line with the Mental Capacity Act 2005 (MCA). Applications were made to the local authority in line with the Deprivation of Liberty Safeguards (DoLS) when a person needed to be deprived of their liberty in order to be cared for safely.

People were able to be independent and this was encouraged where it was safe for the individual. For example, people were supported to make meals. Some people were able to go out of the home independently. This had been assessed and measures were in place to ensure their safety when they did so.

There were systems in place to manage medicines. People's preferred ways of receiving their medicines were taken account of.

Staff reported they felt well supported by the registered manager and able to raise any issues or concerns. There were systems in place to monitor the quality of the service.

We found that notifications to the Commission weren't always made. We found example of DoLS authorisations that had been granted but that had not been notified to the Commission in line with legislation.

We found one breach of regulations during this inspection. You can see the action we took at the end of the full version of this report.

On 07 January 2014 when we carried out our inspection we found that people were not always protected from the risk of infection. This was because risks within the environment had not been identified and remedied. We had found that bathrooms and toilets throughout the home had pipework and sinks that were boxed in with fibreboard which was degraded and could not be cleaned thoroughly, creating an infection control risk. We had also found the bathroom on the first floor had mould in the shower where the sealant had perished, the glass shower doors were dirty and the shower drain was rusty.

The provider sent us a copy of an invoice that was dated 31 March 2014. The invoice was for work carried out for refurbishment of the three bathrooms in the home. The invoice also stated that a new disabled bath had been fitted. We were sent digital photos of the new bathrooms. The photos showed that the bathrooms were of a suitable standard and infection control risks were now minimised. New baths, one of which was designed to meet the needs of people with disabilities had been fitted in each bathroom. New tiles had been fitted in each bathroom. We saw that new pipework attached to the baths and sinks had been put in place. This meant that environment was safe for people who lived there.

There was a programme of activities available and people told us they could choose to attend or not. People's care needs were assessed and care was delivered in line with their assessed needs.

People were protected from abuse and staff knew what action to take if abuse was suspected.

People were not always protected from the risk of infection due to poor infection control systems in the bathrooms.

There were sufficient numbers of staff at the home but on occasion the home could be short staffed.

The provider had an effective system in place to monitor the quality of the service.

We met with one person, making their own lunch in the kitchen designated for people to use. They told us they found the home to be very friendly and liked living there. They described the staff as 'very supportive and helpful' and said they were never pushed to do something they didn't want to.

We spoke with six permanent staff and two bank staff. All of the staff were positive about working at the home. Some had only worked there for a short while but said they felt included. They told us they felt supported by senior staff and said they had good training opportunities.

We met with a visiting health professional who was complimentary about the way staff were receptive to advice given by them and cooperative, working for the benefit of the person they supported. They told us they saw staff being respectful towards the person.

A visitor said they were made to feel welcome and felt 'staff do a good job'.

We found outcomes were met.