Archived: The Spinney

People using the service, The Spinney, live in one building, called The Spinney. There are 52 one or two-bedroom flats each with their own front door onto shared corridors, spread over three floors. There are other shared facilities such as lounges, assisted bathrooms, a hairdressing salon and a dining room where the housing provider offers people a cooked lunch. The domiciliary care agency that we were inspecting (The Spinney) has an office on the ground floor.

Not everyone living at The Spinney receives a service from the agency. CQC only inspects the service, which people provided with the regulated activity ‘personal care’ receive; help with tasks related to personal hygiene and eating. Where people do receive personal care we also take into account any wider social care provided. Thirty-nine people were receiving personal care at the time of the inspection.

The inspection visits to the service’s office took place on 7 August 2018 and 18 September 2018. Both visits were announced. For the first visit we gave the service 24 hours’ notice as we needed to be sure that there would be someone in the office. The delay in carrying out the second visit was due to the availability of the inspector.

There was 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 they run the service.

At our inspection in August 2017, we rated The Spinney Requires Improvement in two key questions, safe and well-led, and Requires Improvement overall.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well-led to at least good. At this inspection we found that the provider had made improvements to keep people safe and to report issues appropriately. However, although the provider had reported events to the local safeguarding team and had investigated those events appropriately, they had not always sent the relevant notification to the CQC. The law requires providers to notify CQC of notable events that happen in the service and this had not always happened.

People felt safe and were protected as far as possible by staff who were trained to report any avoidable harm or abuse. Staff had assessed any potential risks to people and had put measures in place to reduce the risk. There were enough staff to meet people’s assessed needs in a timely manner and keep people safe. The provider’s recruitment process reduced the risk of them employing unsuitable staff.

Staff followed the correct procedures to prevent the spread of infection and knew how to report any accidents and incidents. Staff had undertaken training in how to give medicines safely and as they were prescribed.

Senior staff carried out assessments of people’s needs to ensure that staff were able to meet those needs in the way the person preferred. The provider used technology, such as an alarm call system, to enhance the care provided by the staff.

New staff received a thorough induction during which they shadowed more experienced staff. Staff received training, supervision and support so that they could do their job as well as possible. Staff helped people to make their own breakfast and evening meal, if the person needed help. The housing provider supplied a three-course lunch in the dining room, which staff from the agency served. Staff involved other healthcare professionals to support people to maintain their health.

Staff supported people to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and their relatives made positive comments about the staff. Staff treated people kindly and showed they knew each person well. People were involved in planning their care and support. Staff respected people’s privacy and dignity and supported people to remain as independent as possible.

Care plans gave staff detailed guidance relating to the care and support each person needed so that people received personalised care that was responsive to their individual needs.

A complaints process was in place and the registered manager responded in a timely manner to all complaints. The provider had a process in place to meet people’s end-of-life care needs when the person needed this.

Staff felt supported by the registered manager and the care team leader. Staff were clear about their role to provide people with a high-quality service, thus upholding the provider’s values. Staff liked working for this service.

The provider had a quality assurance system in place. The system included a number of ways in which people, their relatives and staff could give their views about the service and how the provider could improve it. Various members of staff carried out audits and monitoring checks on aspects of the service.

The registered manager worked in partnership with other professionals to give people joined-up care.

This comprehensive inspection took place on 6 July 2017 and was unannounced.

There was a registered manager in place. However, they were not present during this inspection and had been away from the service since February 2017. Since February 2017 a registered manager from another service had supported the care team leader with the day-to-day running of 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.

People were at risk because appropriate systems and processes were not in place to keep them safe and staff had not protected people from harm. When safeguarding incidents had happened, referrals to the local authority safeguarding team had not been made. This meant that staff and management had not reported incidents where people had been harmed.

Risks to people who used the service were not identified and systems were not in place to assess and manage all risks to people. Staff understood some of these risks but not how to minimise them for people whose behaviour was at times challenging.

Notifications, which provide information about important events, had not been sent to the commission as required by law.

The provider's policy on administration and recording of medication had been followed by staff. Audits in relation to medication administration had been completed and had identified areas of improvement required.

People had had their needs assessed and reviewed so that staff knew how to support them and maintain their wellbeing. People's care plans contained person centred information. Staff treated people with care and made sure that their privacy and dignity was respected all of the time. There were sufficient numbers of suitably trained staff to provide and meet people’s health and care needs.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and could describe how people were supported to make decisions. Training had been provided and staff were aware of current information and regulations regarding people’s consent to care. This meant that there was a reduced risk that any decisions, made on people's behalf by staff, would not be in their best interest and as least restrictive as possible.

The provider had a recruitment process in place and staff were only employed in the service after all essential safety checks had been satisfactorily completed. Training was available for all staff which provided them with the skills they needed to meet people’s health and wellbeing requirements.

People were involved as far as possible, in how their care and support was provided. Staff checked people’s health and welfare needs and acted on issues identified. People were supported to access health care professionals when they needed them. Where this support was required, people were provided with a choice of food and drink.

People and staff were able to provide feedback and information about their view of the service. There were systems in place to monitor and audit the quality of the service provided and to drive forward any necessary improvements. However, these had not always identified all areas requiring improvement.

There was a system in place to record complaints. These records included the outcomes of complaints and how the information was to be used by staff to reduce the risk of recurrence.

Staff meetings, supervision and individual staff appraisals were completed. Staff were supported by a registered manager from another service, a care team leader and a senior carer during the day. An out of hours on call system was in place to support staff, when required.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.