Housing 21 - Alrewych Court

Updated 20 May 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced. We called the provider when we arrived at the premises to check key information related to COVID-19 to help reduce associated risks and to help keep everybody safe.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We looked for any feedback available from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

Before our site visit, we spoke with six relatives of people using the service. During our site visit, we spoke with the registered manager and assistant manager. We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

After our site visit, we spoke with six people who used the service and three staff members. We continued to seek clarification from the provider to validate evidence found including records about two people’s care. We spoke with two professionals who regularly visit the service.

Updated 20 May 2021

Housing 21 - Alrewych Court is an extra care scheme providing personal care to 25 older adults at the time of the inspection. People using the service lived in their own flats within one adapted building. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Our inspection identified a breach in relation to good governance because systems did not always effectively assess, monitor and improve the quality and safety of the service. Our inspection was prompted in part by concerns that were brought to CQC’s attention about the service. Before our inspection we had also asked the provider to investigate potential concerns but they had not done so in a thorough or robust way. We also found records were not accurately and fully maintained in relation to people’s needs and risks. This was an ongoing area of improvement identified at our last inspection, which had still not been fully addressed. Audits had not identified this and ensured records were always accurately maintained. This did not demonstrate and reflect the positive support described otherwise by people using the service.

Before our inspection, we had been notified of a number of financial abuse and theft allegations at the service since and before our last inspection in June 2019. The provider had also alerted the police and local authority of these concerns as required. People we spoke with told us they felt safe and had no such concerns.

Discussions during our inspection indicated people were appropriately supported including in response to incidents. The registered manager told us how incidents were responded to however we found records were not maintained about this to demonstrate the full learning and analysis carried out to prevent future risks.

People who received support with their medicines told us they were satisfied with this support. While improvements had been made to medicines management since our last inspection, we saw one area of improvement identified at the last inspection had still not been fully addressed.

Staff were recruited safely and there were enough staff to meet people's needs. Staff followed the infection control procedures the provider had in place. Staff spoke positively about their roles and told us they felt supported.

People told us they would feel comfortable speaking up if they had any concerns. People were routinely asked for their feedback about the service although people’s individual care reviews were less frequent. People expressed very positive experiences of using the service when giving feedback to the service and during discussions as part of our inspection.

The registered manager understood their legal responsibilities in regard to safeguarding and notifications.

Rating at last inspection

The last rating for this service was Good (published 24 August 2019).

Why we inspected

We received concerns about people’s experiences including in relation to allegations of abuse and infection control. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Housing 21 - Alrewych Court on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.