Archived: Sue Ryder - Cuerden Hall

With 38 beds and countryside views, the service provides care and support to people aged 18 and over with complex neurological needs, such as multiple sclerosis, acquired brain injury, cerebral palsy, Parkinson's disease, Huntington's disease and motor neurone disease. A number of the people at the home have lived there for a number of years.

This inspection took place on 12 February 2018, and was unannounced.

At the last inspection on 21 July 2016 we found that the service was in breach of Regulation 12: Safe care and treatment, as the provider did not have suitable arrangements in place to make sure that care and treatment was provided in a safe way for service users.

We also found a breach in Regulation 18 Staffing: the provider did not ensure that sufficient numbers of suitably qualified, competent, skilled and experienced persons were deployed in order to meet the requirements of the regulation. The service was given the rating: Requires Improvement.

At this inspection, we found that the service was no longer in breach of the Regulations, and that no further breaches were found. The service has been given the rating: Good.

Staffing levels and the deployment of staff were now assessed, monitored and reviewed on a weekly basis against the assessed needs of the people living at the home. Risk assessments and risk management strategies were now in pace for all people living at the home. These were regularly reviewed, and if changes were needed then these were swiftly implemented in order to ensure people’s safety was promoted and protected.

We found that the registered manager had acted on our recommendations made at the previous inspection in 2016. We found that the principles of the Mental Capacity Act (MCA) were now embedded in practice within the home, and all the relevant documentation is now completed in line the MCA. People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.

Changes in people’s needs were now recorded in a timely manner and any involvement by external professionals involved in people’s care was clearly recorded. Quality assurance processes now ensured that any risks or shortfalls in care were identified and deal with in a timely fashion.

A registered manager was in post at the service. 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 registered manager and management team were passionate about ensuring people at the service had a good quality of life and were supported safely. They worked well with outside professionals and took on board advice and guidance to make a positive difference to the care and support people received. They used information from complaints, mistakes and incidents to learn lessons and improve safety.

There was an open culture at the service which meant staff felt able to raise concerns freely and know that something would be done as a result. People at home, their families and visiting professionals told us the registered manager and management team were approachable and visible.

Staff had received training on ensuring people were kept free from harm and abuse. They were confident in management dealing with any issues appropriately. Good risk assessments and emergency planning were in place. Accidents and incidents were monitored and we noted that these had lessened in this service. Staff were trained in infection control and supported people in their own environment.

Staffing levels were suitable to meet the assessed needs of people in the service. Staff recruitment was thorough with all checks completed before new staff worked with vulnerable people. The organisation had robust disciplinary procedures in place.

Medicines were well managed. People had their medicines reviewed by their GP and specialist health care providers.

Staff we spoke with to displayed a caring attitude. They understood how to support people and help them maintain their dignity and privacy.

There were regular internal and external audits of all aspects of the service. Changes were put into place after evaluation of the service. Good recording systems were in place and these covered all the support needs of the people in the service.

Sue Ryder - Cuerden Hall provides 24 hour care for people with complex neurological needs. Accommodation is provided over two floors and is mixed between single and shared rooms. The service is provided from a large Grade II listed building which retains many original features, located in 11 acres of parkland.

The service is easily reached from nearby motorway links. Ample parking space is available to the front of the home.

The service is registered to provide accommodation for persons who require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury. The service is registered to accommodate a maximum of 38 people, on the day of our inspection there were 36 people using the service.

There is 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.

We found that there were shortfalls in staffing at the service which had a negative impact on the care and treatment people received. We found risk assessments had been undertaken during peoples initial assessments and plans to reduce risks had been drawn, however these were not always followed.

We looked at how the service managed people’s medicines. We examined medicine administration records [MARs]. MARs did indicate that people received their medicines at the times specified.

Staff told us they knew how to report safeguarding concerns and felt confident in doing so. We felt reassured by the level of staff understanding regarding abuse and their confidence in reporting concerns.

We reviewed recruitment records of four staff members and found that robust recruitment procedures had been followed.

We looked at how the service gained people’s consent to care and treatment in line with the MCA. We found that the principles of the MCA were not consistently embedded in practice. We found that peoples capacity to consent to care had not always been assessed and decisions recorded. People who used the service told us staff were skilled at their job and well trained.

The staff approached people in a caring, kind and friendly manner. We observed lots of positive interactions throughout the inspection. We observed staff speaking with people who lived at the home in a respectful and dignified manner. Staff understood the needs of people they supported and it was obvious that trusting relationships had been created.

Records showed people had their needs assessed before they moved into the service. This ensured the service was able to meet the needs of people they were planning to admit to the service.

We found people’s involvement in their care plan was not always recorded so it was unclear if people had a say in the care they received. We saw care plans were updated when people’s needs changed. This information was not always clear to see and was held on a number of different documents. This resulted in some of the changes not the most up to date information as the person’s needs had changed again.

We found a positive staff culture was reported by all the staff members we spoke with. People's views had been gathered using effective systems. These included regular resident and staff meetings. A number of audits were undertaken to help ensure that quality of the service, however these were not always robust and some were lacking. We found the registered manager receptive to feedback and keen to improve the service.

We have made some recommendations about ensuring the principles of the Mental Capacity Act are embedded in all practice, updating care plans and involving others and ensuring robust audits are in place to improve the quality of the service.

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

"I was asked what level of support I wanted, right down to what sort of sheets I prefer on the bed...They're really accommodating."

"I'm very involved in what care I receive, I've had lots of input into my plan."

"They support me well and support my family too."

"There's plenty of opportunity to go out to town or other trips out and there's always something going on here to keep me busy."

"It's always clean and tidy."

We found the provider went to significant lengths to involve people and their families in decision making with regard to care and support. People were treated with dignity and respect.

People received care and support that met their needs in a safe and person centred way. The service ensured people had access to other health care professionals when required. People had the opportunity to get involved in a variety of activities and trips out of the home.

The home was clean and hygienic. Staff were aware of their responsibilities with regard to cleanliness and infection control. The premises were well maintained and adaptations had been made to keep people safe and help them maintain independence.

The provider had effective systems in place to monitor and assess the quality of the service. People and their relatives were frequently asked for their views, to ensure the service continued to meet their needs.