Housing 21 - Alrewych Court

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.

Housing 21 – Alrewych Court is an Extra Care Housing provision and domiciliary care service providing personal care for people aged 55 years and over. There were 24 people using the service at the time of the inspection.

People 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

People told us they felt safe and received their calls on time. People told us they received safe support with their medicines. Staff showed awareness of people’s risks and how to help promote their safety. Appropriate action had been taken in response to concerns and suspicions of abuse.

People described their care as effective and staff told us they had enough training and support for their roles. People were supported appropriately with meals and to access healthcare services if required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and relatives described the service as caring and praised the approach of staff. People’s views were sought and people were treated with dignity and respect.

People spoke positively about the support provided. Staff knew and followed people’s preferences and routines. Plans were underway to ensure people’s end of life care wishes were known. Complaints had been responded to appropriately although documentation about this was not always complete.

Feedback from people and staff reflected an open, caring service and staff spoke positively about their roles. Areas of improvement identified at the last inspection had not been fully addressed. Records related to people’s risks and medicines support were not always accurately maintained to reflect the safe support people described.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Good (August 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence of continued good practice however the provider needs to make improvements. Please see the Well-Led section of this full report. The provider continues to take action to improve in these areas and we found no evidence during this inspection that people were at risk of harm from the concerns identified.

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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Alrewych Court is an extra care housing scheme that provides accommodation and care for up to 54 people. As part of the scheme the service is registered with CQC to provide personal care to people living at the scheme. At the time of the inspection there were 30 people using the service for support with personal care. There was a registered manager in post. 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.

People were protected by a staff and management team who knew how to recognise and report potential signs of abuse. Staff understood the potential risks to people’s safety and knew how to reduce the risk of harm to people. People were supported by sufficient numbers of care staff who had been recruited safely for their roles. People did not always receive their medicines as prescribed.

People were enabled to consent to their care and support. People were cared for by staff who had the skills to support them effectively in most areas of their care. People were supported to meet their nutritional and day to day health needs.

People were supported by a staff team who were caring in their approach and understood their needs. People were enabled to make day to day choices about their care. People’s privacy, dignity and independence were promoted and they were treated with respect. People were supported to maintain important relationships with friends and relatives.

People and their representatives were involved in planning and reviewing their care. The care people received met their needs and preferences. People were supported to take part in leisure opportunities. People told us they knew how to complain and felt confident their concerns would be addressed by management.

People told us the service was well-led and they felt supported by the staff team and registered manager. People were supported by a committed, motivated staff team who felt supported. Quality assurance checks were completed across the service to identify areas for improvement and further develop the service provided to people. Where improvements were required in these quality assurance systems the registered manager proactively made changes.

During the inspection, we found some of the people who lived at the Court had care requirements. Staff were available 24 hours a day to provide care and support to people who lived at the Court. Alrewych Court was not required to be registered with CQC for accommodation, as people were living in their own homes. They were registered to deliver personal care to people; this is the area we looked at during the inspection.

The care staff we spoke with were knowledgeable about the care requirements of the people who lived at the Court and those who received domiciliary care. Care plans were in place and being further developed to support staff in the delivery of consistent care and support. This included supporting people with their prescribed medication.

An induction process was in place for newly appointed staff. Staff also had access to an annual update of mandatory training, for example moving and handling, nutrition and infection control. A schedule was in place for staff to receive annual appraisals and regular supervisions with a manager or senior member of staff.

There was a complaints process in place; the people that we spoke with told us they were aware of the complaints procedure. People were confident their complaints would be listened to and managed appropriately.

Alrewych Court was an Extra Care Housing provision for people aged 55 years and over who had care needs. Staff were available 24 hours a day. Alrewych Court are an extra care housing provision therefore they were not required to be registered with CQC for accommodation, this was because people were living in their own homes. They were however registered to deliver personal care to people, this is the area we looked at during the inspection.

Alrewych Court also provided domiciliary care to people living in the community. The service was previously located at Arbor House, Butts Street, Walsall, and had recently moved to Alrewych Court. This service is now managed from there.

We viewed training records and spoke to staff about training. The staff we spoke with told us training was available to support their knowledge and development. We saw records that confirmed that staff had one to one supervisions and appraisals with a senior member of the care team or the manager.

During the inspection we looked at the process the service had in place to monitor the quality of the service it provided.