The Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during the inspection. The Hall also oversees a small supported living service but plans to register this separately from the residential service were underway at the time of inspection. Although registered to provide personal care none of those people currently in supported living required the regulated activity at this time, this was therefore not looked at during the inspection.The Hall provides support to up to 10 people who may have a learning disability or autistic spectrum disorder. At the time of the inspection eight people were living at the service.
The Hall was last inspected on the 31 March and 1 April 2016 and rated requires improvement as a result of six breaches of regulation. We found shortfalls in the checks made during staff recruitment, night time staffing levels, staff training, medicine management, care plan personalisation, inadequate health and safety checks and tests of equipment and inadequate mitigation of known risks for one person. The provider had also failed to notify the Care Quality Commission of authorisations approved by a supervisory body and systems for monitoring quality and safety were not always effective. Following that inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-Led to at least good.
At this inspection we noted that clear improvements had been made in most areas with three breaches fully addressed and two others with clear improvements made but more needed to ensure the right level of criminal record checks are made for all staff to ensure they are suitable to work with both adults and children, and the implementation of an appropriate induction programme for new staff and the annual appraisal of staff performance. A system of quality monitoring and assurance remains under developed and lacks a mechanism for gathering the views of relatives and health and social care professionals to help inform improvements and developments. A new breach in respect of the induction of new staff without care qualifications and the lack of staff appraisal has been issued.
The provider is actively involved in the running of the service and a registered manager is in place for the day to day running of the service. A registered manager is a person who has registered with CQC to manage the agency. 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 agency is run.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
Although this was a challenging behaviour unit staff supported people who were unsettled and expressing behaviours in a calm assured manner, the atmosphere in the service was therefore relaxed. Whilst people were not seen to seek out each other’s company, they were comfortable in the presence of others and enjoyed approaching or engaging with staff. People said they were happy living in the service; they liked their rooms, and the activities they did and liked the staff that supported them. A health professional told us staff knew and understood people’s needs well, staff were knowledgeable about the people they supported they spoke about them respectfully and affectionately. Relatives said on the whole they were satisfied with the care their family members received and they felt able to share their views with staff when they had concerns.
The premises have been redecorated; equipment serviced and weekly and monthly health and safety checks and tests are undertaken. Staff undertook cleaning tasks and enabled people to live in a clean environment. There were enough staff available to support people and this was kept under review. Staff received an appropriate range of training to inform their knowledge and understanding, they felt there was good communication and team work, they felt supported and able to express their views and be listened to.
People had opportunities to express their views and concerns on a one to one basis with staff weekly and through weekly house meetings, they understood the complaints process and used this effectively. Staff were provided with additional support through individual supervisory meetings with the registered manager and also staff meetings. The registered manager and staff used handovers, communication books, and circulated written information to ensure effective communication about people's needs and any changes. Staff were trained to recognise and respond to abuse and were aware of their responsibilities to keep people safe from harm.
The facility existed for people to move through the service to less supported accommodation in a timescale that best meets their needs, there were opportunities for skills development and increased independence. Known risks were well managed, behaviour management strategies were developed with health professionals and these were having a direct impact on the reduction of behaviours for some people. People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice
People were supported to keep healthy, and staff were proactive in supporting people to access health professionals. Changes in health needs were incorporated into care plans to ensure staff understood changed support needs. There were clear processes in place for the management of medicines. People were provided with access to drinks when they wanted them, healthy eating was promoted but people’s choices were respected.
A holistic process was used for the assessment of new people referred to the service to ensure their identified needs could be met. Transitional visits and stays were arranged as part of this and consideration was given to the views of existing people and staff. Care plans were developed from this and people had input into these via weekly meetings with key workers; relative’s views about their family members care and support were also sought through reviews and other contacts.
There was ongoing maintenance and investment in upgrading to improve the physical appearance of the premises and make this a more pleasant environment to live in
People were supported to do the things that interested them and to have a visible presence in their local community, they had individual activity plans. They attended a day centre in the community where a range of activities could be offered to them; Learning opportunities and support to seek educational courses and employment if this was appropriate were also available.
We made a recommendation about staff training
We made a recommendation about staff recruitment
This is the second consecutive time the service has been rated Requires Improvement. There was one continued and one new breach 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.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.