16 July 2012
During a routine inspection
We observed five people who lived at the service (downstairs) over two hours including the lunchtime period. We also observed others in the dining room during lunch. We looked at how staff interacted with people and how care was being provided to support people with their needs. We looked for clear and observable signs which would show us how people felt about the care they were receiving.
We also spoke with two visiting relatives.
We saw evidence that people were offered choices in terms of where they wanted to sit, what they wanted to eat or drink and to a limited extent of what they wanted to do. They were also provided with adapted crockery to maintain their skills and independence. There was mixed evidence in terms of whether they were treated with dignity and respect. We saw that some staff were warm and kind, but that they did not always communicate well with people living at the service. This meant that people were being treated as tasks to be done rather than some staff taking the opportunity to interact with people and make lunchtime a happy and enjoyable occasion.
We saw it was documented that one of the people we observed received their medication in their food. This meant it was being given covertly or without their knowledge. The records and our observations indicated that this person lacked capacity to consent to this aspect of care or treatment. This had been assessed, though there was no best interests assessment to justify staff taking this action against the person's wishes.
We found mixed evidence in terms of whether people's care and welfare needs were met. Relatives told us the nurses were good but that some staff did not understand people's needs. We observed this to be the case. We found the records about the delivery of care were not well maintained and were in some cases inaccurate which could lead to risks to the health and wellbeing of people living at the service.
We observed a person over lunchtime whose behaviour could be challenging. We witnessed the person regularly hit out at staff, who did not seem to be using any techniques to try and calm or divert the person. We observed that care had not been provided in line with the person's care plan and that a number of triggers were present and ignored by staff. This placed people living at or visiting the service at risk of injury and the person themselves at risk of retaliation by people living at the service.
During the course of this inspection we found evidence which led us to be concerned about whether there were sufficient staff to meet people's needs. We also had concerns about the way the providers had decided to move staff between two separate locations and concerns were expressed to us from a number of sources about the impact of this inconsistent approach on people living at the service.
We also looked at the quality and monitoring systems in place. People did not give us any direct feedback about this but we found the systems were not effective in securing improvements to areas of concern the providers had identified.