We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well-led?
This is a summary of what we found -
Is the service safe?
Staff followed safe medication practices at the home. We saw all medicines were locked away, to prevent unauthorised access. We found medicines were safely administered. Staff who handled medication had received training on safe management and administration of medication and their competency had been assessed. This ensured they had the skills and knowledge to manage people's medicines safely.
There were policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. No applications had needed to be submitted to deprive anyone of their liberty. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This ensured there were proper safeguards in place.
Is the service effective?
Equipment such as hoists and adapted baths were provided at the service to meet people's needs. Equipment was serviced to make sure it was safe to use. Staff had been trained in moving and handling techniques to make sure they carried out manoeuvres safely.
Is the service caring?
People's privacy and dignity were respected. We observed personal care was carried out behind closed doors. We noted people who used the service had been supported to look presentable in clean, co-ordinating clothes. Clothes protectors were used at meal times to prevent spillages soiling people's clothing. We saw staff wiped people's mouths after the evening meal, to remove any traces of food.
People were supported to be independent. Staff provided people with aids and adaptations to help them manage their evening meal. For example, plate guards and adapted beakers. This meant some people could manage to eat their meal without support from staff. Staff supported people to access the community. For example, going into town to buy clothes, having pub lunches and attending the surgery for GP appointments.
Is the service responsive?
Care plans were in place for each person. These provided a comprehensive account of the support people required. We saw risks to people's safety and welfare were identified and measures put in place to reduce the likelihood of injury or harm. People had access to healthcare professionals, such as GPs and the consultant in learning disabilities, to help keep them healthy and well.
Is the service well-led?
The provider had a system of carrying out annual quality assurance audits of its services. The last annual audit took place in April 2013 and showed the home was providing good standards of care to people. The next annual audit was due to take place shortly after our inspection, to re-assess standards of care.
There was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. Risk assessments were in place, such as personal emergency evacuation plans, moving and handling assessments and nutritional screening. These had been kept under regular review to ensure information was correct and reflected people's needs.
The provider had a system to regularly assess and monitor the quality of service that people received. However, we saw this had not been fully implemented at the home. We found monitoring of the service had not been undertaken monthly by senior management, as expected by the provider. This meant the quality of care had not been regularly assessed and monitored in line with the provider's guidelines, to ensure it was meeting people's needs.