The Radcliffe

The service was not always safe. Some risks to people were not managed or planned for effectively. Action was not always taken after incidents to reduce the risk of recurrence. Medicines were not always managed and administered safely. Staffing levels at night were not always safe or sufficient to meet people's needs. The environment was not always safe. We found evidence the service was in breach of 2 regulations around management of risk, medicines and staffing.

Despite our findings, people told us they felt safe and had their needs met. There was a safeguarding policy in place which staff were aware of and followed. Incidents had been reported to safeguarding where appropriate.

We fed back our concerns to the management team after our first inspection visit, and they took prompt action. On our second inspection visit, we found improvements had been made.

People's needs were not always assessed before they came into the service. Care provided to people did not always follow best practice guidance. Feedback was mixed about whether people and relatives had been involved in care planning, with some saying they had and others saying they hadn’t. The providers Mental Capacity Act policy was not always being followed which could have led to people being unlawfully restricted. Despite this, people told us they could make choices about their care.

We observed that staff were kind and caring towards people. People and their relatives told us the staff treated them with kindness. People felt respected and treated as individuals. However, improvements were required to ensure care was planned to meet people’s needs in a person-centred way. Improvements were required to ensure that care planning and risk assessment reflected how people could be supported to be independent.

Improvements were required to ensure people received person centred care. People told us they were not able to have regular baths and showers, which records confirmed. This had improved by the second inspection visit but provision of baths and showers was still infrequent. Staff and leaders did not always demonstrate a good knowledge of providing care to people living with dementia. The service was not always adapting information to ensure it was in line with individual communication needs. There was a complaints procedure in place and people told us they did not have any complaints at present. During our visits, people were mostly engaged in activity by staff. People made positive comments about activity provision.

In discussions with staff and leaders, it was clear there was not a shared view on what good quality care looked like. The governance system in place to oversee the quality of the service was ineffective. We found widespread issues across the service which impacted upon the care people received. Whilst we observed staff were kind and caring towards people, the inaction of the service in respect of incidents, risk management, medicines management and care planning placed people at risk of harm. Prior to our inspection, the local authority raised concerns about the management oversight of the service. They had been raising concerns with the service but many of these concerns still remained by the time of our visit. This meant we were not assured that an effective system was in place to bring about improvement.

Staff meetings were taking place and some relevant aspects were discussed and direction given to staff, but we found no evidence of this was monitored and how the manager ensured the issues identified were acted upon.

There was a complaints process in place and the registered manager was able to explain us the steps they would take if they received a complaint. There were no records of complaints received by the service. People told us they did not have complaints about the service.

The provider was extremely responsive in acting on the concerns we identified during our inspection. On our inspection visit, we found improvements had been made in relation to staffing, medicines, managements of risks, staff’ training and plans were in place to address the other areas of concern.