This unannounced inspection took place on 18, 25, 28 August 2015 and 03 September 2015. The home is a residential care home and provides support, assistance and personal care for up to 64 older people, including people who have dementia. At the time of our inspection there were 61 people using the service. The home is purpose-built and comprised of four units spread out over two floors, a ground floor and a first floor, accessed by stairs and a lift. The first floor was designated for the care of people with dementia. There was an outdoor garden space and a court yard for people to use.
The home was last inspected on the 13 May 2013 and found not to be meeting the standards in the management of medicines and assessing and monitoring the quality of the service. People were not protected against the risks associated with medicines and care plan audits had not identified inaccurate information. A medication audit did not identify medication recording and procedural errors.
There was a registered manager who had recently started work at the service from 30 June 2015. The registered manager had begun to identify some areas for improvement and development at the home, including changes to shift patterns and shift handover sessions. 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.
There was not enough suitable staff to keep people safe and meet their needs. People were not receiving the care they needed because staff had left or were absent due to sickness or holiday and new staff had not been replaced in sufficient time. People and their relatives told us that staffing levels were not consistently sufficient to keep people safe or meet their needs.
People were not protected from abuse because two staff did not recognise the signs of abuse and were unaware of the risks that some people’s behaviour presented. People were at risk from physical and psychological harm from each other yet two staff accepted that this was usual behaviour.
There were inconsistencies in how risks to individuals were assessed and care plans did not always reflect people’s current care and support needs. Risks relating to falls and poor balance had not been updated following changes to their needs.
Plans were discussed with staff, actions taken and changes were made in response to recent emergencies so that learning from these events improved safety.
Medicines were not being managed safely. Medicine charts for 12 people were found to have gaps, making it difficult to tell whether people had received their prescribed medicines on time.
In June 2015 a fire inspection by the fire service found that certain fire equipment and system checks had not taken place and fire drills and staff training was not adequate. However since the fire inspection findings, action was taken to resolve and address this.
People were cared for by staff that did not have up to date plans to develop their knowledge and skills. There were inconsistencies in staff’s experience of recruitment, training, supervision and support. Staff reported mixed experiences which meant that some staff received regular support and training while others did not.
People told us that the food was ‘excellent’. There was variety and choice of meals including fruit, nutritional snacks and refreshments throughout the day.
People were given support to maintain their health through regular contact with health professionals including dentists, occupational therapists and GPs.
Where people lacked mental capacity to make decisions for themselves they were assessed and staff were made aware of how to support people with their decisions. Staff explained that some people had best interest decisions made to help keep them safe.
On several occasions we saw staff from one unit carry out care that did not respect privacy or reflect dignity when supporting people with their meal and when checking someone’s skin. Staff comforted people when they were distressed. They asked people questions to clarify and understand their concerns and promote their well-being
People and their relatives told us staff respected them, acknowledged their choices and called them by their preferred name.
Some people did not receive individual care and support in a personalised way to meet their needs. Arrangements to regularly assess, record and review people’s care needs did not always take place. Care needs were not always reviewed and managed in a practical way to reflect changes.
Equipment and resources were made available to help people retain their independence. These included rim edged bowls and plate guards to help people manage their food and hand rails to support people when they moved about the home.
Written complaints had been investigated, explored and responded to, although some people and relatives told us that while their verbal concerns were acknowledged, these were not always fully addressed and resolved. Compliment letters sent by friends and relatives about people who had died or moved on expressed positive comments about peoples experiences.
While quality checks were used to measure, monitor and review the delivery of care not all checks identified gaps in care or changes that required redress. Emerging themes from quality checks were not picked up and follow up actions from these checks did not show how some gaps we identified were being addressed.
Care records and other records including staff training plans were not robust and did not sufficiently reflect what was happening on a day to day basis.
Staff told us there had been a lack of clear leadership and management of the home until recently and this had led to confusion about roles and responsibilities and low staff morale. People and their relatives expressed concerns about the changes in management and how this had affected their care.
The recently appointed registered manager was aware of the responsibilities involved in delivering an effective and well-led service and had started to address some of the challenges.
You can see what action we told the provider to take at the back of the full version of the report.