26 September 2017
During a routine inspection
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.