Archived: Optima Care Limited - 34 Lancaster Gardens

Throughout the inspection we set out to answer our five questions:

Is the service safe?

Is the service responsive?

Is the service caring?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and the manager. It also includes what we were told by visiting professionals and some feedback from people's relatives.

Is the service safe?

The service was safer since our last inspection because the interim manager and staff had taken action to address some of the previous shortfalls. Risk assessments had been completed for people going out in the car and for moving and handling people. A safety shield had been fitted to one of the vehicles to prevent incidents in the car. When people using the service displayed challenging behaviour staff now had clear guidelines in place to follow.

Is the service responsive?

The service was responsive because the provider had completed an action plan and organised the support and training the staff needed to meet the needs of the people using the service. Staff training had been carried out and was ongoing. Not all the staff had received all the training required so further training was planned.

There had been further staff changes since the last inspection. Some staff had left employment and two new staff had been employed. The team continued to be supported by agency staff so that there were sufficient staff. An information folder had been compiled for agency staff which included profiles of the people using the service and some of the relevant policies and procedures to give them information about the service.

Is the service caring?

Staff were kind and caring when speaking with and in the presence of people using the service. We observed that people smiled more and appeared more calm since our last inspection. Care plans were referred to by staff for guidance and contained people's preferences. However, the planning and delivery of care to some of the people using the service needed to be developed to meet individual needs.

Is the service effective?

The service was more effective since our last inspection because staff had direction and support from the management team. There was a structure in place for the day and each staff knew what their role was. Communication assessments had been carried out and all people using the service had a communication passport, which described how the person expressed themselves and their understanding. Communication aids had been introduced, although some of these were not the right type to help some individuals and were under review.

People using the service had plans in place to support and manage their behaviour and staff had been given guidance and training by the interim manager.

The management team had introduced a system to regularly check the quality of the service to protect people's health, safety and welfare.

Is the service well led?

Since the last inspection the manager resigned and the provider put interim management arrangements in place. Leadership in the service had improved from the last inspection because staff were clear about what they needed to do to support the people using the service. People in the home were more settled. People's days were more varied with a choice of activities.

During both days we spent time talking to staff and people using the service and observing the interactions and practices in the home. We also had discussions with the manager and looked at some of the care records. On the second day two inspectors returned and were in the homes in the afternoon only.

Throughout the inspection we set out to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and the manager. It also includes what we were told by visiting professionals and some feedback from people's relatives.

Is the service safe?

The practices in the home did not protect the people who used the service, staff or visitors from the risk of harm. Serious concerns were raised regarding the lack of guidance for staff to support people safely and to manage their behaviour appropriately when it was challenging. One person was at risk and put others at risk when they were in the car because there were insufficient safeguards in place. We saw several near miss accidents when two service users were in one of the kitchens.

People were not protected from discrimination. One of the people using the service was not able to have a bath or participate in preferred activities because the appropriate support and equipment was not available.

There was no system in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns, whistleblowing and investigations. This increased the risk of harm to people and failed to ensure that lessons were learnt from mistakes.

Checks on the safety of the building and equipment in the home were ineffective because they did not pick up faults and rectify them. Refurbishment was needed to comply with fire safety legislation.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affect people's safety and ensure that systems are in place to make sure the home is safe.

We found that people's medicines were managed safely and that people were supported to take their medicines appropriately.

Is the service effective?

The service was not effective. There was no direction for staff and the support to people using the service was inconsistent and unstructured. There was no means for people with communication difficulties to express their views. The service was for people with behaviours that challenged and yet, there were no systems in place to manage these behaviours, to recognise triggers or to encourage positive behaviour. Staff worked long shifts which ended at times that did not support evening activities.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and delivering appropriate care and support.

Is the service caring?

Staff spent time with people and chatted to them. People were given choices but they were not always followed through because there were so many distractions. Staff tried to occupy people with activities but there was no structure to make it meaningful. There were no activities that would provide new opportunities or skill development. Staff recognised that people's behaviours were a way to communicate but had no support to manage these effectively.

Is the service responsive?

There had been some staff changes and there was a shortage in the team which had been covered by agency staff. There were no plans and guidelines available for agency staff so when they gave care or responded to people's behaviour they were corrected by the more experienced staff in the team because it was the wrong support.

There were no communication support plans in place despite involvement with the community speech and language therapist.

People using the service looked unsettled and anxious.

One person was particularly angry because they had changed their minds about moving bedrooms and were not allowed to move back to their original room.

Is the service well led?

There was no clear leadership in the service. Staff were given conflicting guidance from the management team and nothing was written down which led to confusion and inconsistency with the care provided. A new manager had recently been employed and was trying to put guidance in place for the staff but this had only just begun. There was a lack of policies and procedures for staff to refer to.

There was no quality monitoring system to reflect on what was being provided and no development plan in the service.

People were supported to make decisions about their day to day lives and things that were important to them. They could choose when to get up and go to bed, what to do each day and staff respected their choices. People indicated to us they liked their rooms and had chosen the colour schemes for them.

Staff understood people's needs well and their individual preferred methods of

communication. People had good relationships with staff and we observed they were comfortable spending time with them.

People were supported to be as independent as they could and to learn new skills. People could make their own meals if they chose and helped with their laundry and some household tasks.

People indicated they were happy with their bedrooms, that they were clean and tidy and that they had been asked about how they wanted them decorated and furnished.

There were enough staff on duty to support people safely and the organisation had

processes and procedures in place to check on the quality of the service people received and to keep them safe.

We spoke with five people living in the homes. People told us that they liked the home and they had a good lifestyle. One person said, "I like it here." One person shared their interests and talked about recent activities, "I've been horse riding on a carriage. This afternoon I am going to have lunch and watch a movie." People said the staff helped them and listened to them. People were given the support they needed to make decisions about their care and treatment. One person needed some medical treatment and a best interests meeting was held so that the person was able to understand and participate in the decision making. People were supported to maintain relationships that were important to them with their families and friends. We found that there were enough staff to support each person, so that they were able to develop their independence and choose how they wanted to spend their time. Staff were able to attend training and said they were well supported by the manager.