Background to this inspection
Updated
27 October 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2014 and to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was unannounced and carried out by one inspector on 26 September 2017.
Prior to the inspection we reviewed information we held about the service including statutory notifications. Statutory notifications include information about important events which the provider is required to tell us about. We also looked at information included in the provider information return (PIR) which the provider had submitted to CQC to inform us about the service and any improvements or development they were planning to improve the service. We received information from service commissioners.
During the inspection we spoke with three people who used the service however due to their complex health needs they were unable to fully express their views. Therefore following the inspection we spoke with three relatives to obtain their views and experience of the service. We spoke with three staff members, two of whom were permanent staff and one agency staff member and the registered manager. We received information from service commissioners. We viewed information relating to two people’s care and support plans. We also reviewed records relating to the overall management of the service.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not give us detailed feedback about their experiences due to their complex health needs.
Updated
27 October 2017
The inspection took place on 26 September 2017 and was unannounced. The last inspection was on the 5/10/2016 when the service was rated as requires improvement overall.
5 Tavistock Avenue is a small residential care home providing a care for up to three people with a learning and or physical disability. At the time of our inspection three people were living at the home. One person had recently been moved to the service from another service managed by the provider. This was to enable them to carry out some essential maintenance and refurbishment of the other property.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
People’s relatives told us that the care and support provided at the home was appropriate to meet their needs. However we found that people did not always receive the support they needed to access or engage in meaningful activities outside the home. Staff told us that there were not enough staff available to support people to meet their individual needs. Some activities had been provided on a planned basis, but this was limited to the availability of staff. People were provided with a choice of food and drinks. People were supported to access healthcare services to help maintain their health where appropriate.
There was a robust recruitment process in place to help ensure that staff were of good character and suitable for the roles they performed at the service. However the process for completing similar checks for agency staff were less robust.
People were able to communicate with us in a limited capacity but indicated that they felt safe living at the home. Risks to people’s safety and wellbeing were managed. However versions of peoples risk assessments were not always dated. People’s medicines were managed safely. Staff had received training in safeguarding people from potential abuse and were able to tell us the process for reporting concerns.
Staff had received training to help them to provide safe support for people however, for some staff the training had expired and they required refresher training. There were no assessments undertaken to assess the knowledge and competencies of the staff team.
Staff felt supported by the management team, and the new registered manager was in the process of introducing new systems and processes to help ensure support arrangements were more consistent. Staff had completed training in relation to the Mental Capacity Act 2005 (MCA) but were not always clear on their responsibilities and people’s rights under the Act.
Record keeping was not always robust. Peoples care records did not always demonstrate that people were involved in the planning and making decisions about how and when their care was provided. People’s dignity was not always respected or considered. Care records were not always dated and there were several copies of similar documents so we could not tell which the current care record was. Reviews were also not consistently completed and where changes had happened, care plans and risk assessments did not always reflect the changes.
There were no recent quality monitoring records and the provider’s systems were not robust and had not identified shortfalls we found during our inspection. The registered manager had only been working at the service for a short time and had identified some areas which required improvements. However these had not yet been implemented.
There were no systems in place to obtain regular feedback from people who use the service. Although people were invited to individual reviews of their care, it was not evident that anything changed as review documents recorded ‘no change’. Meetings were not held to enable people the opportunity to discuss the wider issues in a supported group environment and so did not empower people.
Relatives of people who used the service told us that they felt the home was generally well run. However there had been several changes of management which meant there was a lack of a consistent approach to managing the service.