28 November 2016
During a routine inspection
The registered manager at the home had recently left their employment and a new manager had been employed by the service. They were in the process of registering with the Care Quality Commission. On the day of the inspection the new manager had been in post only a few days. 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.
The unannounced inspection took place on 28 and 29 November 2016. At the previous inspection on 15 and 16 June 2015 the service was given a rating of good overall. This inspection was brought forward due to concerns received from HM Coroner around an incident that had happened at the home. The concerns were around the lack of appropriate training in relation to assisting people with swallowing difficulties to eat. Information received from the provider and evidence gathered at the inspection demonstrated that the service had responded to the concerns appropriately. They had produced an action plan, updated staff guidance around assisting people to eat and included more specific instruction and guidance within the nutritional training for all staff.
There was a house manager for each of the six houses as well as two clinical service managers who oversaw the running of three houses each.
People told us they felt safe at the home. Appropriate individual and general risk assessments were in place and these were reviewed and updated on a regular basis.
Staffing levels were appropriate to meet the needs of the people who used the service. Staffing was based on the dependency levels of the people who used the service. Recruitment procedures were robust and the induction of new staff was thorough.
The premises were clean, tidy and warm with no malodours. The premises and equipment were maintained and serviced regularly to help ensure they remained fit for purpose.
There was an up to date safeguarding policy in place and staff were aware of how to recognise and report any safeguarding issues. Safeguarding issues were followed up appropriately by the home. We saw the home’s medication systems which helped ensure medicines were safely ordered, administered, stored and disposed of.
Staff had appropriate skills and training to ensure they were able to administer care effectively. Supervisions were undertaken regularly but recording needed to be more consistent.
The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and authorisation for Deprivation of Liberty Safeguards (DoLS) was sought appropriately.
People’s nutritional and hydration requirements needs were assessed and documented appropriately. Special diets were adhered to by the chef and people were given choice with regard to meals. Food and drink were plentiful throughout the day.
People told us they were treated with respect and kindness and we observed good interactions between staff and people who used the service. Visiting times were unrestricted and visitors told us they were made to feel welcome at all times.
People who used the service and their families were involved in care planning where appropriate. People’s wishes for when they were nearing the end of their lives were documented and their preferences adhered to if possible.
Care plans were person centred and included a range of health and personal information. This included people’s likes, dislikes and care needs. There was a varied programme of activities at the home and people’s preferences for how they liked to spend the day were supported.
Complaints were dealt with appropriately by the service and there were a number of forums for people to put forward suggestions and raise concerns.
The new manager at the home had not yet had time to become established. We were therefore unable to assess her leadership skills. People who used the service, visitors and staff reported that the management team were approachable. Staff meetings took place regularly.
A number of audits and checks were carried out by the home. Some were followed up appropriately but others lacked analysis and follow up actions.