23 August 2016
During a routine inspection
This unannounced comprehensive inspection took place on 23, 24 and 26 August 2016. At the last focused inspection on 11 December 2015, we found that the service was in continued breach of Regulation 17 and in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to ineffective audit systems which although identified issues around health and safety, did not evidence what actions had been taken to resolve those issues. We also found that there was a lack of staff supervisions and annual appraisals. Requirement notices were issued in relation to these breaches for the provider to make improvements in these areas. As part of this inspection we looked at the breaches that were identified at the last focused inspection to check what improvements had been made.
At the last focused inspection the service was not carrying out supervisions and annual appraisals in accordance with their own policy and procedures. During this inspection we found that all staff were receiving regular supervision and had received an annual appraisal. Care staff that we spoke with also confirmed this.
At the last focused inspection in December 2015, we highlighted to the provider that the freezer that was in use in the garage was in a poor state of repair. The drawers were broken and there was a large build-up of ice. During this inspection we found that the provider had still not addressed this issue. The freezer remained in a poor state with mould evident on the seals of the freezer door. We showed this to the manager during the inspection.
At the time of this inspection there was no registered manager for this location. The provider had arranged for their service manager, who oversees all Hillgreen Care Ltd homes, to take up the manager’s position on a temporary basis. 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.
Each person living at the service had a care plan in place. These contained information and some guidance on how people wished to be supported. Risk assessments were available for each person which focused on the activities that each attended and the risks associated with those activities. However, the service did not assess any risks associated with people’s health and mental health conditions. As a result there was little or no guidance available to staff on how to reduce or mitigate risks to ensure people were kept safe from harm.
Care plans were not person centred and did not provide any background information about the person, their health and mental health condition and how they should be supported in relation to these. There was little or no information about how the person’s mental health or learning disabilities that affected their behaviour or mood. Where a person was observed to have behaviours that were challenging there was again none or very little information about the triggers that may escalate a person’s behaviour and the techniques that care staff could use to de-escalate behaviours that may challenge.
The provider, together with other registered managers from the provider’s other locations, completed monthly quality assurance inspections within the home. However, these audits were ineffective and did not highlight any of the issues that we identified as part of our inspection process. Where issues were identified, there was no action plans or systems in place in order to deal with those issues and resolve them.
People told us that they were happy living at 2a Oxford Gardens and we observed them to be well-supported by care staff. We saw positive and friendly interactions between care staff and people. People were treated with dignity and respect.
Care staff that we spoke with demonstrated a good understanding of safeguarding and knew of the different types of abuse that may affect people. Care staff knew whom to report any concerns to and were confident that appropriate action would be taken to protect people from harm.
People were supported to have their medicines safely and on time. There were records of weekly medicine audits and staff had completed training on medicine administration. As part of the training each care staff were observed whilst administering medicine to assess their competency before being allowed to administer medicines alone.
The service followed appropriate recruitment processes to ensure that only staff suitable to work with people were employed. This included obtaining references and completing criminal record checks for each staff recruited. All staff received induction when they first started work with the service followed by regular refresher training in all mandatory topics. However, the service did not provide specialist training relating to identified health and mental health needs of the people using the service.
The manager and care staff had good knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service had followed the correct processes to ensure that where people were deprived of their liberty that this was done lawfully.
During the inspection we looked at the fire extinguishers within the home. We found that the last safety check carried out on the extinguishers was in 2014. We asked the manager about this who told us that checks had been completed in January 2016, however the provider could not evidence this.
At this inspection we found a continued breach of Regulation 17 and further breaches of Regulation 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Warning notices were issued on the provider in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.