SUMMARY: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?
People told us that they were comfortable at the home. They told us that they had access to call bells so that they could summon help quickly when needed.
One person we spoke to told us, 'Staff are respectful and if I had any problems or concerns would speak to the manager or owner.'
We observed staff helping people with their mobility. We noted that assistance was given appropriately and safely. Staff explained the use of equipment and the procedures. This helped to reduce any anxieties service users might have had.
The staff we spoke to confirmed that they had received training with regard to adult protection and abuse. They were able to tell us about the signs of abuse and the processes that were in place to report any suspicions or allegations of abuse. Staff told us that they would not be afraid to speak out if they had concerns about the treatment of people who used this service.
We saw that CCTV had been installed in the hallway and communal lounge at the home. We were told that the camera in the hallway was in use as part of the security systems in place at the home. The camera in the lounge was described by the manager as 'a second pair of eyes.' We raised concerns with the manager and the owner about this camera and the implications it presented about people's privacy.
We found that restrictions had been placed on people who used this service and that there were times when they had been kept under close confinement within the home. Records showed the use of alarms and pressure pads but the records did not include how or why these decisions had been made. It was impossible to tell whether these arrangements were the least restrictive and had been placed on people in their best interests.
We spoke to the owner and registered manager about their responsibilities under the Mental Capacity Act 2005 with regard to the Deprivation of Liberty Safeguards.
We noted that the home was generally clean, tidy and odour free on the day of our inspection visit. There were areas of the home that were not as clean as they might have been and posed a risk to the control and prevention of infections.
We found that the provider had not always recruited new staff safely. Records showed that some required recruitment checks had not been carried out. This put people at risk of being supported by unsuitable staff.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in the planning of their care.
Is the service effective?
We found that people who used this service had received an assessment of their care and support needs but this had not included a detailed assessment of their nutritional requirements. More work was needed with this aspect of people's care needs to help ensure they received appropriate support and interventions when risks had been identified.
Care plan summaries provided useful information about care needs 'at a glance' for care staff, but these documents had not always been updated as people needs changed. This was particularly evident in the care plans of two people who had been identified for 'end of life" care.
The people we spoke to during our visit to the home told us that they were satisfied with the care and support they received and indicated that their needs were met. We observed that people who used this service all appeared well groomed and well cared for.
Risks and support needs had been identified but there were no clear and detailed strategies recorded to help ensure staff managed these safely and appropriately. We observed staff supporting people with their mobility. In the examples we saw we noted that support was given safely and appropriately.
Is the service caring?
The people we spoke to during our visit to the service told us that they were satisfied with the home and the service they received.
One person told us they were, 'Highly delighted with my care and treatment. The carers come in and help me when I need them. The staff are always polite and helpful.'
We were told by someone else, 'It's lovely here. I have regular baths and the food is good. I have a call bell in my room and the staff come quickly if I need them.'
The staff we spoke with were very knowledgeable about the care and support needs of the people who used this service. Staff could tell us about the needs of service users and what was recorded in their care plans.
We observed that staff were caring, attentive and treated people with respect. People were addressed by their preferred name, staff explained procedures to people during moving and handling transfers and checked that people had everything they needed to hand.
We noted that people were able to make choices about their daily lives. For example, what they had to eat and drink, the clothes they would like to wear and where they would like to spend their time.
We noted that people appeared well groomed and adequately supported with their personal care needs.
Is the service responsive?
We found that people who used this service had not received an assessment of their nutritional needs and support. There was some evidence of people having their nutritional intake and body weight monitored. More work was needed with this aspect of people's care needs to help ensure people received appropriate support with their nutritional requirements.
We spoke to the provider about the gaps in the care planning process. They told us that staff knew the needs of service user's. They told us that they, and the manager, 'Speak to the residents every day' so they knew about any changes to needs.
No one raised any current concerns or complaints with us. People told us that if they had any problems or concerns they would speak to the provider or the home manager directly. One of the people we spoke to told us of about an unpleasant incident they had experienced in the past. They told us that the provider had dealt with the matter to their satisfaction and that 'everything is alright now.'
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in the planning of their care.
Is the service well led?
We saw that there was an annual development plan for quality assurance and a business plan to help ensure any planned improvements for the home stayed on track.
No one raised any current concerns or complaints with us. Only one person told us that they had previously made a complaint about the service. They confirmed that the provider had listened to their concerns and that they had been dealt with appropriately.
There was information available to confirm that systems were in place to assess and monitor the quality of service provision. However, they needed to be developed further and implemented consistently across the service to help demonstrate they were effective.
The provider had procedures in place to help ensure a safe and good quality service was provided. However, we found that these were not always followed. For example, there were gaps in the staff recruitment processes. We found that restrictions had been placed on people with no recorded evidence of best interests assessments.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.