Archived: 26a Sussex Avenue

26a Sussex Ave is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a manager at the service who had submitted an application to CQC to register prior to the inspection. The manager was supported by a team leader and assistant team leader. 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 last inspection in November 2016, we found concerns about works which needed to be completed at the service and a lack of consistent staff resulting in a reliance on agency staffing. At this inspection some improvements had been made. However, some larger pieces of work remained ongoing. The housing provider was in the process of becoming the provider for care services. Once this was completed, a plan for a complete refurbishment of the service would be actioned. People, families and commissioners had all been kept up to date with the plans and what would be happening. As a result some work at the service remained outstanding.

Agency staff were still used to cover shortfalls, but the number of permanent staff had increased. The manager had worked with the agency to build a core team of agency staff who worked at the service. There were enough staff and they had the training and support required to meet people’s needs. Improvements had been made to how staff were allocated, which they told us helped them understand their responsibilities. Staff were recruited using safe procedures to ensure they were suitable to support people.

People’s care was given in a person centred way; however people’s care plans would benefit from more detail and information being displayed in a consistent way. There was a risk that staff may not know where to find some information as it was recorded in a variety of places in each care plan. One care plan had been updated as a pilot, this was much improved and there was a plan to replicate this for each person. We have made a recommendation about this.

Relatives told us they were asked for their views via surveys and felt able to complain. However, some relatives did not feel that concerns raised had been addressed fully and to their satisfaction. They told us that although improvements had been made there was ‘still a way to go’ in resolving issues and communicating effectively. We made a recommendation about this

Staff understood their responsibilities in relation to keeping people safe and who they could report any concerns to. Risks to people and the environment were assessed and plans were in place which gave staff the guidance they required to minimise risks. Lessons were learned from accidents and incidents. For example, documents to record when people’s health deteriorated had been updated as the result of a recent safeguarding. People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this. When people had limited communication staff used communication tools to support them to express themselves and where appropriate involved loved ones in making choices.

People had complex health needs; staff worked closely with local health care professionals to ensure people had the support they needed to remain healthy. When people had long term health conditions staff were proactive in seeking support. Relatives told us that communication about people’s health had vastly improved. People’s medicines were managed safely by trained staff, in the way people preferred. People had access to a range of food and drinks which they liked and which were presented in a way that met their health needs. People were encouraged to remain hydrated throughout the day.

People took part in a range of activities which they enjoyed including accessing local day services. Staff were working with people to expand their knowledge of things people enjoyed and to increase the range of activities they accessed. The service had been designed to meet the needs of people who required support such as wheelchairs, walking aids and hoists. Staff understood the need for infection control measures and were seen to use gloves and aprons when required.

There was a shared vision for the service and staff told us the management team were approachable and supportive. Systems had been implemented to support staff to improve communication with each other, relatives and other professionals. However, these were not yet embedded and staff were still adjusting to new ways of working. Audits were completed to monitor the quality of care provided to people and the environment. Any shortfalls formed the basis of an action plan which the management team completed. CQC had been informed about incidents as required and the service had displayed their rating in the entrance hallway.

This is the first time the service has been rated Requires Improvement.

The service is a purpose built detached bungalow providing accommodation and personal care for 10 people with learning and physical disabilities. The service is split into two different units; The Willows and The Oaks. Each unit has five bedrooms, shared bathrooms, a lounge and dining room. The kitchen is in the centre of the home and is shared by both units. There were seven people living at the service when we inspected. Each person had restricted mobility and relied on staff to move them around the service in their wheelchair.

A registered manager was not in post. 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.

The service was last inspected in April 2016, when it was rated as Requires Improvement. At this time we found four breaches of Regulation and issued requirement actions. Regulation 12, the provider failed to ensure the safe administration of medicines and prevent the spread of infections. Regulation 15, the provider failed to properly maintain the premises and equipment. Regulation 17, the provider had failure to ensure there were effective systems for the governance of the service. Regulation 18, the provider had failed to notify CQC of events and incidents without delay. We asked the provider to take action to make improvements in these areas and this action had been completed when we inspected the service on 23 and 24 November 2016.

There was a manager at the service but they were not registered with the Commission. During the registration processes applicants are assessed to see if they have the necessary skills and knowledge to manage a care home. .

There were enough staff available to support the people at the service as agency staff were used to cover staff vacancies. The high percentage of staff vacancies at the service affected staff morale and their consistency in providing personalised care. People had complex needs and limited communication and therefore, it took time for staff to get to know them and their preferred routines

Effective processes were in place to undertake checks on staff to ensure they were suitable for their role.

Staff knew how to identify and report any safeguarding concerns in order to help people keep safe.

There were safe systems in place for the storage and disposal of medicines. Staff received training in how to administer medicines and had their competency in this area assessed.

A schedule of cleaning was in place to ensure the service was clean and practices were in place to minimise the spread of any infection.

A formal supervision programme had been introduced so staff received regular support from senior staff. There was a rolling programme of essential training for staff to ensure they had the

skills and knowledge to care for people effectively. Specialist training had been undertaken in autism and learning disability, epilepsy and sensory impairments.

People had their health and dietary needs assessed and clear guidance was in place to ensure they were effectively monitored. People received the support they needed to eat and medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made and renewed, to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so.

Staff were kind and caring and treated people with dignity and respect. They communicated with people in a way they could understand and involved them in decisions about their care.

People were offered a range of activities inside and outside of the service which took into consideration their interests and abilities.

People’s care, treatment and support needs were clearly identified in their plans of care and included their likes, choices and preferences. People’s feedback about the service was gained on a daily basis and information was available to their relatives and visitors about how to raise a concern or complaint.

The manager at the service was approachable and the atmosphere in the service was relaxed and informal. The manager was supported by a staff team who understood the aims of the service and were motivated to support people according to their choices and preferences.

Systems were in place to review the quality of the service and feedback was sought from people, their relatives and staff.

The service is a purpose built detached bungalow providing accommodation for 10 people with learning and physical disabilities, who require personal care. The service is split into two different units; The Willows and The Oaks. Each unit has five bedrooms, shared bathrooms, a lounge and dining room. The kitchen is in the centre of the home and is shared by both units. There were nine people living at the home when we inspected. Each person had restricted mobility and used wheelchairs to move around the home, most people relied on staff to move them around the home.

The service had a registered manager. 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.

Some areas of the home were not suitably clean. Infection control procedures were not suitable to protect people from the risk of infection, cloth towels were in use in the staff toilets and appropriate bins were not in use throughout the home.

Equipment had not been suitably checked and maintained. Beds had been missed off the servicing arrangements and fire safety checks had not taken place frequently. A fire exit was found to be blocked twice during the inspection.

Medicines had not been administered following the provider’s medicines policy and following good practice guidance. Medicines records were not accurate and complete.

Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. Policies and procedures were not up to date in relation to safeguarding which meant that staff did not have up to date and relevant guidance. We made a recommendation about this.

Staff had not received regular supervision; we made a recommendation about this.

People enjoyed the food; meals were served according to people’s assessed needs. People helped to choose the food on the menu. We found prescribed thickener in the kitchen which had not been appropriately stored, which put people at risk of harm if it was ingested.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Audits undertaken had not picked up the concerns about infection control, equipment, fire safety, medicines, and care plans records. Records relating to care and support provided were not accurate and complete.

The provider and registered manager had not notified CQC about important events such Deprivation of Liberty Safeguards (DoLS) applications in a timely manner. The Registered manager had let CQC know about other events such as safeguarding concerns and problems affecting the central heating.

There were enough staff on duty to meet people’s needs. Staff had undertaken training relevant to their roles.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA), which included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner. The staff ensured people received effective, timely and responsive medical treatment when their health needs changed.

Interactions between people and staff were positive and caring. People responded well to staff and engaged with them in activities. People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People and their relatives had been involved with planning their own care. Staff treated people with dignity and respect. People were supported to be as independent as possible.

People’s information was treated confidentially and personal records were stored securely.

People’s view and experiences were sought during meetings and through quality assurance surveys. Relatives were also encouraged to feedback through surveys.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift were documented, they were detailed and thorough.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People received support to maintain a healthy, active lifestyle. They were able to pursue a variety of hobbies and interests in the home and out in the community. People were assisted to attend health care checks and community health professionals were involved to provide advice and support when needed. A healthy balanced diet was offered to people who were able to choose the food they ate and were involved in the preparation of meals as much as they wanted to be.

The home was safe, well maintained and suited people’s needs. Each bedroom was single and personalised and reflected people’s interests.

There was a clear recruitment process and new staff said they received the training they needed and were well supported when starting work in the service.

We spoke with some people and also observed the interactions between the people and the staff. We observed how people responded and reacted with the staff and we observed to see if people indicated they were happy, bored, discontented, angry or sad.

People who use the service indicated that they were happy at the home. They were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond in a caring and positive way.

Staff knew the people well and were able to communicate with them using a range of methods. If people were unhappy about something the staff were able to recognise the signs and take the appropriate action to resolve any issues.

Staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

People received support to maintain a healthy, active lifestyle. They were supported to attend health care checks and community health professionals were involved to provide advice and support when needed.

People received their medicines when they needed them.

People and their relatives could be confident that any concerns or complaints they had would be listened to and acted on.