An adult social care inspector and pharmacy inspector carried out this inspection with the help of an expert by experience. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?As part of this inspection we spoke with 10 people who use the service, six relatives, the registered manager, a representative of the provider and six staff. We observed how people were supported and cared for. We reviewed records relating to several people's care as well as records relating to the management of medicines. We also reviewed records relating to complaints, staff training, staff duty rosters and cleaning systems. We also reviewed several documents and records relating to the service's quality monitoring system.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
Is the service safe?
People were safe because staff received updated information about people's condition and needs. People's risks had been assessed and arrangements were in place to reduce these. For example, specialised equipment had been introduced to reduce the risks of pressure ulcer development. People at risk of poor nutrition or falling were monitored and appropriate action taken to reduce associated risks.
There were enough staff to meet people's care and health needs. Although the service had gone through a period where there had been a shortage of its own nurses, agency nurses had been used but predominantly the service's own nurses had worked additional hours. This meant care staff had continued to receive direction on people's care/treatment from nurses who knew people's health care needs well.
There were systems in place to prevent the spread of infection and people lived in a clean environment.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. One DoLS application had been submitted and responded to by the relevant authority in order to deprive one person of their liberty lawfully. Relevant staff had been trained to understand when a DoLS application should be made and how to submit one.
Is the service effective?
The service was effective because people received care that met their individual needs, choices and preferences. Care plans gave detailed information about how people's care should be provided. Staff also received good verbal guidance and information about people's condition and needs. People said, 'I'm very happy' and 'I think we're looked after very well'. One relative said, 'They've got it pretty well sorted out' and another told us the care was "adequate".
Staff delivered people's care with either their consent or after a decision had been made in the person's best interests. Staff were aware of their responsibilities and had the right skills and knowledge to meet people's needs.
People who were at risk of not getting enough food and drink were supported to do so in a way that suited their specific needs. Everyone had access to professionals that provided basic primary health care advice/treatment such as their GP, community nurses and a chiropodist. People with more complex needs had access to health care specialists who advised and supported the staff in how to meet these needs. This included professionals such as a speech and language therapist where there were swallowing problems, a dietician where people had more complex nutritional needs, and mental health specialists.
Is the service caring?
The service was caring because it recognised people had the right to be involved in decisions made about their health and care. One person who uses the service said, "Yes, yes, yes' when we asked if they had been involved in making decisions about their care. When talking to one relative about how decisions had been made about their relative's care they said, 'Yes, I was there, and the social worker' and another said, 'Yes, I was involved. I'd been looking after (name) for 10 years'.
Opportunities were also provided for people to be actively involved in making suggestions and decisions about the service. For example being able to choose the colour scheme for the dining room, requesting more pictures and pot plants. This meant staff recognised the service as being the home of the people who use it.
We observed people being treated with respect and dignity. We observed staff making sure people were decently covered when transferring them in a hoist. Staff were kind and patient with people who required additional time and attention such as those who were confused and had dementia. Reassurance and encouragement was given to people in a way that did not belittle them.
Where people had needed support from staff to wash and dress they had been given choices on what they wore and time had been taken to help them looked groomed and feel comfortable. Caring was also shown in little ways such as making sure people's spectacles were cleaned and polished. A relative said, 'I do not want to be a nuisance but I come in every day' and they said they "felt welcomed'. Relatives told us they were always offered a cup of tea when the trolley came round.
Is the service responsive?
The service was responsive because it responded to people's care needs and to when these needs altered. There were examples of people being provided with more care and monitoring when it was needed as well as staff recognising when people were more able and wanted more independence.
Staff sought additional support or intervention from appropriate people when needed. Referrals were made to health care professionals and other services when advice or support was required and their advice was followed.
When people raised a concern/complaint the service responded according to the provider's (the company's) complaints policy and the issues raised were investigated. This was done in a way that aimed to reassure the complainant, improve people's experiences of the service and learn from the situation.
Is the service well led?
The service was well led because there was a permanent registered manager in post who was approachable and involved in what went on in the service. This manager had provided the service with leadership and had made improvements to the service since starting in January 2014. This improvement had been enabled and continued to develop because good support had also been provided by representatives of the provider. The provider had robust arrangements in place to both support and monitor the registered manager's performance.
People who use the service and their representatives were able to meet with the registered manager. The registered manager was open to receiving feedback on the services provided and suggestions on how the service could be improved.
Leaders within the service were clear about their areas of responsibility. Different departments such as the care team, kitchen, domestics and maintenance team worked together to provide a service that met people's needs. The performance of these departments and of individual staff was monitored to ensure people's safety and welfare was maintained. Staff were provided with training and support to improve their knowledge and practice. The culture of the service was one of being committed to looking after the people who use it and to improve their quality of life.
There were arrangements in place which resulted in accidents and incidents being reported. Accidents such as falls were analysed to look for trends/patterns which helped staff take appropriate action to prevent a reoccurrence.