The inspection took place on 3 November 2015 and was an unannounced inspection.
Since our previous inspection on 3 December 2014 the provider had ceased to provide nursing care from this home. The home provided residential care to older people and people living with a dementia. The home was set out over two floors and was registered to provide care for 68 people. However, the manager told us that there was only space for 64 people. One area of the home was called The Willows and this was a secure unit for people living with dementia.
There was a manager at the home; however, they had not completed their registration with us. 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.
At our previous inspection on 3 December 2014 we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that there were not enough staff to support people effectively and staff did not receive effective training. Medicines were not safely administered and people were not fully supported against the risks associated with inadequate food and hydration. Care was not fully planned to keep people safe and meet their needs and people were not treated with consideration and respect. Systems to assess and monitor the quality of the care and identify, assess and manage risks were ineffective.
At this inspection we found the provider had made the necessary improvements and was no longer in breach of any regulations.
The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. Where people may lack the capacity to make decisions for themselves capacity assessments had been completed. Where people were unable to make decisions, these had been taken in their best interests after obtaining their views of friends, relatives and health and social care professionals. Where people were at risk of being deprived of their liberty they had been appropriately referred to check if a DoLS was needed.
There were enough staff to meet people’s needs. Staff had received appropriate training and support to provide safe care to people which met their needs. However, this was not always fully embedded in their work. Staff were able to identify how people may be harmed and knew how to report any harm to their senior care staff of manager. However, they were not always aware of how to raise concerns with external organisations.
Care plans recorded risks people were exposed to while receiving care and the action to be taken to reduce the risk. In most cases care was delivered in line with the care plans to keep people safe. However, lack of understanding of pressure relieving equipment by care staff in the dementia unit meant people were not fully protected from the risk of pressure damage. Care plans were structured so information was easy to find and most contained information needed to keep people safe. However, care plans for people in the dementia unit did not contain information on when to administer medicines prescribed to be taken as required or around diabetes care.
People’s medicines were ordered, stored and disposed of safely. Staff had received training in how to administer medicines safely and we saw they followed that training. However, urgent medicines were not always obtained in a timely manner.
The care provided met people’s needs and was delivered at a pace appropriate for the person being supported. Care staff and other staff were kind and respectful to people receiving care. People were offered choices in their everyday lives and were involved in decisions about their care. Activities were provided and people had the opportunity to be involved in planning activities for the home.
The mealtime experience was pleasant and planned. Nutritional assistants supported people to eat and people’s nutritional needs were identified. People had been appropriately referred to health care professionals for advice and support.
The manager had improved the culture in the home and staff identified that they trusted and respected the manager. Staff were focused on providing person centred care and felt supported to do so. The systems in place to monitor the quality of care provided were effective and people living at the home and their relatives had been able to evaluate the service they received.