We inspected the home in response to information of concern. We had been informed by a third party of an incident where someone living at the home had allegedly been unable to summon assistance at night using their call bell. In addition, we received information that suggested there might not be sufficient adequately trained staff at the home.Two inspectors carried out this inspection, arriving at the home at 5am. We found one nurse and two other care staff awake on night duty. They were employed by the provider rather than working for an agency. The provider and members of the home's management team were present from around 7am. There were 21 people living at the home on the day of our inspection.
The name of a registered manager who no longer works at the home appears on this report. At the time of our inspection they had recently resigned and had not yet applied to cancel their registration. The home was supported by an acting manager.
The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.
We considered our inspection findings to answer questions we always ask:
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found.
Is the service safe?
Prior to the inspection we had received concerns that there were not always sufficient qualified, skilled and experienced staff to meet people's needs. We found that there were enough staff to meet people's needs. Staff rotas reflected adequate staffing. Two people we spoke with both said that staff came quickly when they needed them. We observed that call bells were answered promptly when they rang. Staff told us they undertook training relevant to their roles and the provider's records confirmed this. Staff told us they were happy working at the home and said there were enough staff to enable them to care for people safely. They said agency staff often worked alongside existing staff, but these were generally agency staff who worked there regularly. The provider informed us that they were in the process of recruiting permanent care staff to reduce the need for agency staff and we met two care staff who had recently been employed at the home.
People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The provider had taken steps to provide care in an environment that was adequately maintained. We observed that the building was visibly clean, tidy and kept at a comfortable temperature. It smelt clean and fresh throughout. The d'cor, furniture and fixtures we saw, such as hand wash basins and toilets, were clean and intact. Some rooms had recently been refurbished and others were being redecorated at the time of the inspection. We saw some radiators in the lounge that were not covered. The acting manager informed us of the measures taken so that these would not present a risk to people. The provider informed us that there were risk assessments in place for any uncovered radiators. However, following the inspection the acting manager was unable to locate these and sent us copies of new risk assessments. The acting manager subsequently found the original risk assessment and provided us with a copy.
People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. At the front of one person's care file, there was a 'do not attempt to resuscitate' document that related to someone else who lived at the home. People's care files were not well maintained and, where people had resided in the home for some time, contained duplicate and out-of-date information. Some records of care were incomplete. When recording dates, staff had often recorded the month and year instead of the specific date.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS), which apply to care homes. The home did not meet the legal requirements relating to DOLS. The management team informed us they had learned only the previous day of a March 2014 Supreme Court judgement about DOLS. This judgement requires that people who are unable to consent to living in a care home have DOLS in place if they require continuous supervision and control and are not free to leave. People living at the home were subject to continuous monitoring of their wellbeing. Four people's care records we looked at indicated that they may not have understood they needed to live in residential care for their safety and wellbeing. However, management staff told us that no-one living at the home was subject to DOLS. They said that they would review whether DOLS were required for people living at the home and would apply to the local authority accordingly.
Is the service effective?
Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. People were not asked for their consent to the use of bed rails and there were no records of decisions made in line with the requirements of the Mental Capacity Act 2005 that this would be in their best interest. Care records did not contain evidence of people's consent to their care, or records of mental capacity assessments and best interest decisions in line with the requirements of the Mental Capacity Act 2005.
All the people we met looked clean, well kempt and comfortable. The two people we spoke with told us they were comfortable and received the support they needed.
Is the service caring?
People's privacy, dignity and preferences were respected. We spoke with two individuals, who told us that staff were kind and polite. Two established members of staff were able to tell us in detail about people's preferences and the support they needed. We saw that staff assisted people in a kind and respectful manner.
Is the service responsive?
The home's management ensured the home would be able to provide the level and type of support people needed before they moved in. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan and in a way that was intended to ensure their safety and welfare. We saw that staff followed people's care plans, although we did not observe intimate care. Where we were unable to observe care we looked at relevant records that showed staff had taken the necessary actions to meet people's needs.
Is the service well-led?
The provider had an effective system to regularly assess and monitor the quality of service that people receive, and to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. People who use the service, their representatives and staff had recently been asked for their views about their care and treatment through a quality assurance survey. The provider took account of complaints and comments to improve the service. There was evidence that learning from accidents and incidents took place and appropriate changes were implemented.