The inspection team consisted of one adult social care CQC inspector. On the day of our inspection 40 people used the service. We spoke with four people, one person's relative, one care worker, one nurse, the Head of Clinical care, and registered manager. We reviewed records relating to the management of the home which included eight people's care plans.We considered all the evidence we had gathered under the outcomes we inspected, which related to consent to care, people's care and welfare, suitability and safety of premises, staffing, assessing and monitoring the quality of service provision and records. We used the information to answer five key questions; is the service safe, effective, caring, responsive and well-led.
This is a summary of what we found.
Is the service safe?
People and relatives of people who use the service were complimentary of how the provider maintained people's safety. One person told us 'I feel safe here.' Evacuation plans were in place to ensure people's safety in the event of a fire at the service.
There were enough staff on duty to meet people's needs. A member of the management team was available on call in case of emergencies outside usual working hours.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to this type of service. While no applications have needed to be submitted for the people using the service, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made, and how to submit it.
Since our last inspection on 11 December 2013 we found actions had been taken by the provider to ensure people were protected from the risk of infection. People had been cared for in an environment that was safe, clean and hygienic. People were protected from the risk of infection because protocols based on current Department of Health guidelines were followed.
The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents. There was a system for monitoring and learning from incidents. The provider could identify possible trends that may require additional actions, such as risk assessments and the implementation of appropriate actions, to minimise the risk of occurrences to people and others.
Is the service effective?
The service demonstrated effective practices through the assessment of people's health and care needs. People's views about the type of care they wanted had been sought. People confirmed their involvement in the development of their care plan. We found staff had a good understanding of people's care and specific support needs, for example, in relation to pressure sore prevention and medical conditions such as Multiple Sclerosis.
All four people and a relative we spoke with were complimentary about the care received. One person we spoke with said 'Everything the staff do they do very well.'
Since our last inspection on 11 December 2013 we found actions had been taken by the provider to ensure where people did not have the capacity to provide consent, the provider acted in accordance with legal requirements. The provider had suitable arrangements in place for formally obtaining the consent of people regarding their care and treatment. For people assessed as lacking the capacity to make specific decisions for themselves, staff did not approach relatives to consent on their behalf unless they were lawfully able to do so. During our visit we saw people were asked for their consent before they received any care, and staff acted in accordance with their wishes. One person told us 'They (staff) always say what they are going to do and get my agreement.'
Is the service caring?
People were supported by kind and supportive staff. One relative told us 'Staff are caring towards X. The care here is absolutely brilliant. This is how a care home should be.' All interactions we observed between the staff and people were respectful and courteous. We saw that care workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed.
The compliments folder we looked at recorded responses from people and their relatives. We saw feedback was positive. People rated staff support and care highly.
Is the service responsive?
People's needs were assessed before they were admitted to the service. Records confirmed people's preferences and diverse needs had been recorded. Staff provided examples of care and support being provided in accordance with people's wishes, for example, in relation to meal preferences and personal hygiene.
We found care was not planned and delivered to meet all of the identified needs for four people who used the service to ensure theirs and others' safety and welfare. For example, in relation to the provision of specific guidance for behaviours that challenge the service arising from the provision of personal care. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring care is planned and delivered to meet the needs of all people who use the service.
People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with by the provider, and found that the responses had been thorough, and timely. People could therefore be assured that complaints were investigated and action was taken as necessary. A survey to gather feedback from people's relatives was conducted in April 2014 by the provider. This recorded up to 18 responses from 42 people's relatives. We saw feedback was positive. Relatives rated management's ability to resolve people's concerns and complaints highly.
Is the service well-led?
We saw people's and relative's feedback was sought through meetings and surveys. The provider was responsive to comments from people, such as improvements to the supper menu and the implementation of a planned refurbishment of the service to meet people's wishes and suggestions.
Audits and checks ensured people's safety and wellbeing was promoted. Where issues were identified, an action plan was formulated. Progress and completion of this was monitored. We saw issues were identified and actions completed appropriately.