Archived: 4 Piggy Lane

There were 10 people using the service at the time of our inspection on this occasion. We talked with four people and reviewed five peoples care files. We conducted a short observational framework for inspection (SOFI). SOFI is a way of observing the experiences of people who may not be able to communicate with us verbally. We spoke with six members of staff and three people's relatives. We also reviewed documents made available to us by the manager.

Two inspectors carried out this inspection and we were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

We considered our inspection findings to answer the questions we always ask; is the service safe, effective, caring, responsive and well led.

This is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found the service was safe. We found epilepsy support plans contained detailed information for each person. Care staff we spoke with were able to show a good understanding of these needs.

Is the service effective?

We found the service was effective. We saw guidance in people files had improved to show up to date information regarding people's needs. For example, we saw that choking risk assessments for one person we identified as being at risk in April had been reviewed to ensure that all staff were aware of their needs.

Is the service caring?

We found the service was caring. We observed across both bungalows that people who used the service benefited from caring and meaningful interactions with staff when receiving support. We found that there was a growing culture that understood that all interactions have the potential to be meaningful.

Is the service responsive?

We found the service was responsive. We found that people's support plans were clear and had guidelines for staff to follow with regard to peoples care. For example, one person had a catheter. There were clear guidelines for care staff to follow in order to support this person and identify any problems. We saw that care staff understood these guidelines and had contacted district nurses immediately when they had identified concerns. We also observed people who required soft diets received appropriate care in line with their support plans.

Is the service well-led?

The service was well led but we found that further improvements needed to be made. We found that the audits we saw in April had been embedded in the culture and these had been done more regularly to support the action plan from our previous visits. Each of these audits had been effective in identifying improvements which had also been acted upon.

We also found that despite overall improvement in people's records, that people's personal records were not always accurate and fit for purpose. We found records that had been implemented to support the safety and wellbeing of people were not always being used.

There was also two occasions where we saw peoples support plans not always being followed or communicated to care staff accurately.

The provider provided an action plan as to how they were going to address the issues and said that all actions would be completed by the 30 March. Due to the level of our concerns at the last inspection we re-inspected soon after this date in order to see if progress was being made. We found that improvement had been made.

We inspected this service over two days. On both days of our inspection the manager was not available and the newly appointed support coordinator had also been off but had returned by the second day of our inspection. The service was being managed by a care coordinator and service managers from other services.

There were ten people living in the two bungalows that make up this service during our inspection. We communicated with six people, and reviewed six people's support files. We also spoke with eight care workers, support coordinators and senior managers and reviewed documents provided to us by management. We also spent time walking around both homes and conducted two SOFI observations.

We considered our inspection findings to answer questions we always ask;

Is the service safe, caring, effective, responsive and well led?

This is a summary of what we found '

Is the service safe?

People were not completely safe from avoidable harm, although improvement's had been made since our last inspection. People we communicated with felt safe and their needs were well documented within care files. However the needs documented, and how these needs were to be met, did not always reflect the most recent recommendations made by healthcare professionals. For example, guidelines in people's epilepsy and rescue support plans were not always being carried out because staff were not always aware of the most recent guidance that had been provided.

Support coordinator audits had been introduced by the manager to ensure information about people's needs was being exchanged between staff effectively. However, we found this system had not been delegated in their absence which meant that people's safety could not always be assured.

Environmental audits included health and safety checks. We found that a number of issues regarding the safety of the environment had been identified through a recent audit and were in the process of being resolved to ensure the safety of the premises and people within it.

We reviewed newly updated safeguarding protocols that clearly documented what to do if people were being harmed or if abuse was suspected.

Is the service caring?

Piggy Lane provides a caring service which is delivered by care workers who showed warmth, compassion and respect for the people they supported. Care staff understood the needs of people they supported and involved other professionals when necessary. People we communicated with felt cared for. One person told us, 'the staff are nice, they care about me, they know what I like'. Other people, who could not communicate verbally, indicated they felt cared for by smiling and/or by their hand gestures. People were supported to maintain appropriate health checks such as visits to the dentist, and were also supported to access the community and maintain an active social life. Over the two days of our inspection we observed that people attended friendship groups and witnessed people going on shopping trips and visiting museums.

Is the service effective?

We found that improvement had been made since our last inspection, but the service was still not always effective. We found that care workers were effective and identified peoples changing needs. However we found the system for ensuring that new information was recorded in care plans and exchanged between staff was not effective and had the potential to put people at risk.

We found that staff received training to meet people's needs and that a central system highlighted when updates were required. We found that more robust systems of auditing quality and safety had been introduced. However, these systems were in their infancy and were not yet sufficiently effective at the time of our inspection.

The care people received meant that positive outcomes were being achieved as people were being supported to maintain an active social life. People were also encouraged to participate in the day to day running of the home and encouraged to make their own choices.

Is the service responsive?

This service was responsive. Care workers we spoke with felt that since the last inspection communication had improved and issues raised were responded to quickly and sufficiently. One care worker said, 'things are so much better, I feel I can go to the office and ask a question knowing I will get a response'. Another care worker told us, 'it has been nice knowing when I raise an issue for a resident regarding their health, I get the support I need'.

We found that when peoples care needs changed the service responded to ensure those changing needs were met. This meant that people were supported by people who were responsive and alert to their changing needs to ensure people wellbeing.

Is the service well led?

We found that positive changes had been made but the service was still not always well led. We found there had been improvements in the leadership and overall culture of this service since our last inspection. Senior managers we spoke with had a clear understanding of the risks in their service and we saw evidence of audits and follow up that improved the quality and safety of the service. However on the day of our inspection key staff were absent and had been for some time, interim arrangements had been made to ensure the service was supported. This had prevented the full implementation and evaluation of the systems designed to improve the quality and safety of the service being provided. Despite managers having an awareness of risks, some areas had not been addressed. Staff we spoke with felt the leadership was clearer and that communication had 'improved dramatically'. Staff also felt they could raise concerns freely without fear and that their feedback was valued. One person said, 'it's a completely different place to work, there is just a better feel about the place'.

We inspected Piggy Lane on 06 January 2014. We had concerns across a wide spread of outcomes, and returned the following day to inspect further.

We were not able to speak with people who used the service. We were able to conduct an observation of the delivery of their care. We observed many episodes of good, personalised care and warm interactions by the care staff. However, they told us that they were not always able to deliver a high standard of care because of long-standing staffing problems. They said they had far too much to do, and this sometimes compromised the safety of the care they could deliver.

We noted that there were insufficient processes in place for the safety of the people who lived there. We were informed of other episodes of safeguarding concern, and noted the lack of records for these incidents. We alerted the local safeguarding team about these.

We checked the medications policy and procedures. We found that one medication was out of date, and a lack of consistency in the way in which stock numbers were kept.

We checked the staff rosters for the previous three months, and the month to come. There were dates where staffing was either inadequate for the requirements of the people who lived there, or inappropriate for the continuing wellbeing of the staff.

There was an organisational failure of effective communication and engagement with staff with extensive local knowledge. We heard that the care staff felt they were "badly-managed" by the two on-site managers, and "let down" by their employing authority, Southern Health NHS Foundation Trust.

We asked for specific records relating to incidents, to safeguarding and for day to day management. These were not able to be found. This impacted directly upon the quality of the service delivery, and the safety of people who lived there.