Archived: Sanctuary Home Care Ltd - Gloucester

Sanctuary Home Care Ltd - Gloucester provides extra care housing where people live in ordinary flats in one building called Middleton House. A range of communal facilities are also available for people’s use, lounges, a restaurant, outside space and car parking. People can receive support with their daily living activities, cleaning and shopping, where needed. Some people receive support with their personal care needs, personal hygiene and eating. CQC only inspects the care service provided to these people. In these cases, we also consider any wider social care being provided. At the time of the inspection 19 people received personal care support.

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

People were complimentary about the service they received. Comments included "The staff are very nice”, “I am really honestly very happy, I haven't got one thing I am concerned about”, "Carers are considerate of my needs", "Best move of my life, staff are very helpful and caring”, 'It’s not like living at your own home but it is the next best thing. I am quite content” and “It’s very nice here. Lovely and warm.”

There had been an improvement in how the service was managed and monitored. The registered manager had introduced additional monitoring processes. These enabled them to ensure actions were taken so the service met with the required standards and regulations and, so the provider’s actions for improvement were fully met and could be sustained. There had been a change in approach which people told us felt more inclusive of their views and feedback.

People told us they found the registered manager to be “Very approachable” and “A very nice person.” One relative confirmed there had been an improvement in their relative’s health since they had moved into Middleton House. Staff told us the service was more organised since the registered manager had been in post. They told us they felt well supported, communication had improved, and senior staff were there to support them when needed.

People told us they felt safe. People felt reassured that they would receive their care as planned. People confirmed that staff responded quickly if they pulled their call bell for support, in between their planned care visits. People had control over who they let in to visit them. Arrangements were in place to reduce the risk of ‘unknown visitors’ entering the building and accessing areas where people lived.

People told us staff were caring and knew how they liked their care to be delivered. People told us the registered manager had acted when staff had not performed to the standard expected and they felt reassured by this. People told us there had been an improvement in the quality of care staff and in the quality of the care provided, since the registered manager had arrived.

There were arrangements in place to ensure staff received the training and support they required to deliver people’s care safely and in line with best practice and current legislation. People’s care was provided in line with their protected characteristics and people’s specific cultural and religious preferences.

People who required support with managing their medicines received the level of support they required. This included, for some people, ordering their medicines, getting them delivered, storing them safely and administering them.

People were supported with their healthcare needs by staff liaising with GPs and community nurses where appropriate, about people’s health requirements. Staff used the emergency services where needed.

Support was provided to people with their eating and drinking, where this was required. This support could be provided wherever people chose to eat, in their flats or the service’s main restaurant.

People’s care was planned with them and people had access to their individual plans of care. Information about people’s care was kept secure. People’s privacy and dignity was maintained, and staff were expected to maintain professional boundaries and confidentiality. Action had been taken where this had not been the case in the past.

The provider had a complaints process which some people had used, and we saw evidence that these complaints had been investigated and addressed. People we spoke with had either not needed to raise a complaint or where they had raised an area of dissatisfaction, this had been addressed and resolved to their satisfaction. The registered manager told us they took a proactive approach when communicating with people and seeking their feedback, so that any areas of dissatisfaction or “niggles” could be addressed immediately.

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.

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

Rating at last inspection

The last rating for this service was Good (last report published 5 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

During this inspection improvements in these areas had been achieved by the interim manager in post. The service however, was still without a permanent and registered manager which had been the case since December 2015. 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. This issue was discussed during this inspection. Following our visit to Middleton House it was confirmed that a new manager was due to start soon and they planned to apply for registration with the CQC. This plan of action will be monitored by the CQC.

Sanctuary Home Care Ltd – Gloucester provide a domiciliary care service to people who live at Middleton House. Middleton House comprises of 49 one and two bedroom apartments for rent or shared ownership. As well as private apartments there are communal areas which people can use and enjoy. These include lounges, a restaurant, hair salon and additional toilet and bathing facilities. Care staff were based at Middleton House and carried out care visits to people who lived there.

The service is safe. People were protected against risks that may affect them. There were arrangements in place to manage known risks and quickly identify potential risks. There had been improvements made to staff numbers and the availability of staff. The service was now able to carry out all planned care visits for the agreed allotted time. Staff were also able to manage additional situations and tasks without this having an impact on people’s planned care visits. For example, visits by and liaising with care and health professionals, additional requests for support (extra care calls), emergencies and maintaining necessary care records. There were robust recruitment processes in place to protect people from those who may not be suitable to care for them. People were protected from potential acts of abuse and discrimination. Staff received training which enabled them to carry out their tasks safely and in line with necessary legislation and people’s human rights. Staff told us they would like some additional training relating to particular illnesses and conditions. The provider subsequently provided us with a comprehensive list of training which all staff received. They also confirmed that staff were able to request additional training, in the illnesses/conditions they had mentioned, through the provider's learning and development team. People’s medicines were managed safely and they received these as they required them.

People received effective care which was provided in a caring and compassionate way. People’s individual choices, preferences and wishes were listened to and supported by the staff. People were treated with dignity and respect irrespective of their diverse needs and beliefs. Staff showed a genuine desire to make people comfortable and to offer reassurance when needed. Staff supported people to live independently but were aware of when additional support was needed. Staff provided necessary support to ensure people ate and drank sufficiently and they helped them access support from health professionals when needed. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and therefore people were supported to make independent decisions about their care. People’s consent and agreement was sought before support was provided. At the time of the inspection everyone had the mental capacity to make independent decisions and to provide consent. However, the manager confirmed that if this were not the case, people’s care would be delivered lawfully and according to the principles of the MCA.

The service was responsive to people’s individual needs and staff included people in the planning of their care. Staff knew people’s particular choices and preferences when it came to how they liked their care delivered. People’s personalised needs and how these should be met were recorded in support/care plans. These records were kept in people’s private apartments so they had access to the information held about them. Copies of these records were kept securely in the care office. Information about people was only shared with their consent and then on a need to know basis only. There were arrangements in place for people to raise a complaint and have areas of dissatisfaction resolved.

The service had not always been well-led but people had benefitted from effective management arrangements having been in place since November 2016. The provider had quality monitoring processes in place. At the time of this inspection these quality monitoring processes were being used effectively, necessary actions had been identified and were being acted on because there were effective management arrangements in place. These improvements and the effective management arrangements needed to be sustained.

This was the service’s first inspection since it was registered with the Care Quality Commission (CQC) in March 2014. This service took place in Middleton House where people own or rent their own accommodation which consists of 49 two or one bedroomed flats. People can purchase different types of support and we inspected the domiciliary care service. This service manages all aspects of a person’s care needs, for example, personal hygiene, nutritional support, support with medicines and organising help with other health care related needs. Visits from the care staff are planned and varied from one to four visits a day. The provider also offered what they called “extra care” at Middleton House. This meant people could call for support in-between their scheduled care visits for an additional charge. Examples of this so far had been people feeling unwell or needing to use the toilet before their next care visit.

In June 2015 a manager was registered with the CQC, but they stopped managing the service on 19 November 2015. 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. The provider had therefore put temporary management arrangements in place until a new and permanent manager could be recruited.

People receiving care told us they were very happy with the service provided. They told us they felt safe, trusted the staff and their needs were responded to well. People received their care visits more or less when they expected to. Some visits had been late and the reasons for this were being addressed. People told us this had not, so far, had a negative impact on them. The care people wanted to receive was planned with them and they gave their consent before any care or treatment was delivered. Where people were not able to do this, due to a lack of mental capacity, the principles of the Mental Capacity Act 2005 were adhered to and people received their care lawfully. Some improvement to the recording of this process was needed and senior managers had already identified this. People received the support they required in order to take their medicines. Some improvements were needed to how the medicines system was monitored but again, this had been identified by senior managers who were improving this. People told us their dignity and privacy was maintained and staff were caring and compassionate.

Staff told us they felt supported by the senior managers and they had received appropriate training to be able to meet people's needs. It had already been identified that some staff would need additional training and guidance to be able to meet some new responsibilities which were planned for their role. Robust recruitment checks ensured people were protected from those who may not be suitable. The use of agency staff had reduced over the last 4 months but where there was still a need for this, senior managers tried to get the same agency staff back so as to avoid too much change for people.

There were arrangements in place to ensure people's areas of dissatisfaction and complaint were managed effectively. The provider’s quality monitoring arrangements were effective and had identified shortfalls in some of the service's systems and processes and these were being proactively addressed.