Archived: 48 Hafod Road

The inspection took place on 20 March 2017 and was unannounced. There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 previous inspection on 8 and 16 August 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, safeguarding service users from abuse or improper treatment,person-centred care, meeting hydration and nutrition needs, and good governance. As a result, we asked the provider to complete an action plan to detail the steps they would take to improve the quality of care provided to people. The home was also placed into special measures, meaning significant improvements were required, or enforcement action would be taken.

At this inspection, we found people's needs had been reviewed and shared with the staff team. Guidance was in place for staff to follow to enable them to keep people safe. People received their medicines safely, and as prescribed.

Staffing levels were determined according to people's needs, both in terms of their safety and their wellbeing. People were able to go out when they wanted as there were sufficient staff to support them with this.

People's eating and drinking needs were known by staff, and professional and medical guidance were followed. Health professionals were involved in staff training to ensure that staff had the necessary skills and knowledge to meet people's needs.

People were encouraged to make choices and be involved in decisions which affected them and their care. Where information had to be presented in a different way, to enable people to make choices, staff adapted their communication style and method.

People's privacy and dignity were maintained, and staff understood the importance of this. People's independence was maintained as much as possible.

People's care plans reflected the individual care and support needs people had, and this information was used to inform staff's interactions with people. People's changing health and wellbeing needs were responded to.

People were supported to maintain their preferred social and leisure opportunities, as well as to develop and try new ones. There was a system in place for responding to and acting on complaints and feedback.

The registered manager had created a positive, respectful environment, which benefited the people living at the home. Routine checks and audits were carried out to ensure a high standard of care was maintained.

The inspection took place on 8 and 17 August 2016 and was unannounced.

There was no registered manager at this service, and there had been no registered manager in post since June 2016. A manager was appointed after the registered manager left, but they had subsequently left before completing the process to become a registered manager. The home was being managed by temporary managers and an acting operations manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 not always protected from harm or abuse. Risks associated with people's individual care and support needs had not been managed.

People did not always receive their medicines safely, or as prescribed by their GP.

People were not supported with their eating and drinking needs. Although people received input from a range of specialist health professionals, their guidance and recommendations were not consistently followed.

People’s privacy was not always respected and maintained.

People could not always pursue their individual hobbies and interests, or access the community when they wanted to.

There was managerial and staffing instability in the home, which impacted upon the quality of care people received. Staff and the provider did not always communicate about people's needs and how to meet those. Staff felt unable to raise concerns with management and were reluctant to raise concerns with them.

People were involved in decisions about their care, and staff understood people's different communication needs. People's independence was encouraged.

There was a system in place for capturing and responding to complaints and feedback.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’.

Services in special measures will be kept under review; if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service Safe?

The people we spoke with told us that they felt their relatives were safe living at the home and their needs were met by staff that knew them. One staff member also told us that they felt people were safe and their needs were met.

The staff we spoke with demonstrated to us that they had an understanding of consent and what to do if people were unable to consent for themselves. This ensured all decisions were made in the best interest of the person.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

We found that people lived in an environment that was safe and suitable for their needs.

We found that the provider made necessary repairs to ensure that the home provided a safe environment for people to live in. We found that improvements were being made to ensure that everyone who lived there could access all areas of the grounds including the rear garden.

We checked the medicines of people who lived at the home. We found that medicines were stored and administered safely.

Is the service Effective?

We observed that people received appropriate care to meet their physical needs and maintain their comfort. All of the staff we spoke with told us about the individual needs of the people that lived there. We found that staff had received training that was appropriate to their roles. For example staff had just completed autism training. Staff told us that they felt this helped them to improve their understanding of people's needs.

Is the service Caring?

We observed that staff were kind and polite. We found that staff treated the people that lived there with dignity and respect. People's needs were met in a caring and dignified way. We observed that staff spoke in a calm and respectful manner with the people that lived there. All of the staff we spoke with were able to tell us about people's individual likes and dislikes. People's wishes had been respected. For example we saw one person ask to go to the local fairground. We then observed that the member of staff made arrangements to make sure that this activity happened.

Is the service Responsive?

We found that the care records showed that people that lived at the home saw other professionals including the district nurses and doctors when their health needs changed. We found that the provider had acted appropriately to guidance from other professionals when people's needs changed. People told us that they felt if their relatives needs changed the staff were always quick to respond and contact other professionals. For example following a change in a person's behaviours we found that a referral for a specialist had been made to provide additional training around the individual needs of a person that lived there. This had been following a period of monitoring of their behaviours by the staff.

Is the service Well Led?

The quality assurance systems in place enabled the provider to highlight and address shortfalls in a timely manner. At the time of inspection the provider had appointed a new manager and deputy manager. We found that staff felt that the changes made to the management of the home were positive, and staff told us that they felt supported in their roles.

During our visit we saw staff treat people in a caring and patient way. Each person had a care plan that detailed how staff should meet their special needs. A new manager had started in August 2013 and they had attended some care reviews with relatives. They had requested the input from professionals in developing further guidance on how to best support people.

The home had six vacant posts due to recent staff turnover. People had sometimes been supported by less staff than they were assessed as needing. The manager told us they were doing everything they could to provide consistent support to people through the regular use of bank and agency staff while new staff were recruited and inducted.

We found that people had a varied and nutritious diet and special needs had been considered along with people's preferences.

Improvements in the environment had started to be made. We found that the provider's system to deal with building repairs was not responsive and long delays had put people at risk of harm from damaged fittings. Fire safety had been compromised because some fire doors would not have closed in a fire.

We found that people were supported in promoting their independence and community involvement. Their diversity, values and human rights were respected. People seemed to like the staff and they were provided with good care and support. They felt safe and were listened to when they communicated any concern or anxieties.

We looked at staff training records and spoke to three staff to get their views. They felt the staffing levels allowed them to spend quality time with people. They said they were well supported and trained. The provider had systems in place to check the quality of the service.