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Inspection carried out on 9 October 2018

During a routine inspection

The inspection took place on 9 and 10 October 2018 and was unannounced. At the previous inspection we found the provider did not have a robust recruitment process in place and concluded this was a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found improvements had been made and the provider was no longer in breach of this regulation.

At the previous inspection we found the provider had not submitted all relevant notifications to the CQC. We found this was a breach of Regulation 18 CQC (Registration) Regulations 2009 Notification of other incidents. We found improvements had been made and the provider was no longer in breach of this regulation.

Since the last inspection Advent House no longer provides nursing care and has updated their registration with the CQC to reflect this.

Advent House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Advent House accommodates up to ten people in one adapted building.

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.

The service has 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 the service is run.

Staff were kind and patient. It was clear they knew people well and how to meet their needs. The systems and processes in place to manage medicines were safe. Risks associated with people's care were identified and managed. However, these were not always documented.

People were supported by sufficient numbers of staff to meet their needs. Staff recruitment records demonstrated the service was ensuring staff were subject to the appropriate scrutiny.

The service followed the principles of the Mental Capacity Act 2005. People were 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 supported this practice.

New members of staff did not receive appropriate training and supervision. There was no clear record of what training staff had undertaken and when it was due to be refreshed. We concluded this was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Care plans contained up to date information regarding people’s care and support needs. People enjoyed meaningful activities.

Staff felt supported and had seen improvements in the home. Staff told us they were asked to provide feedback on the service and felt listened to.

The registered manager and deputy manager completed regular audits in areas such as, Deprivation of Liberty Safeguards (DoLs), finance, accident and incidents, medication, infection control and safeguarding. They had begun to complete audit action plans to ensure issues identified were addressed.

The provider’s audits were contained within the registered manager’s supervision notes. They did not always record the exact information they had checked. Any outstanding actions were recorded so they could be followed up at the next supervision. A monthly operations report was emailed to the provider by the registered manager. However, there was no area within the form for comments or to record any action taken by the operations manager or directors in relation to the information in t

Inspection carried out on 21 August 2017

During a routine inspection

This inspection of Advent House took place on 21 August and 22 August 2017.

At the last inspection on 20 January and 7 February 2017 we carried out a focused inspection in response to a specific incident. We looked at the safe and well-led domains. We rated the service as 'Inadequate' and the service remained in 'Special Measures'. We found two regulatory breaches which related to safe care and treatment and good governance. We served a notice of decision to impose conditions on registration. Following the inspection the provider sent us the information we had requested and an action plan which showed how the breaches would be addressed. There were also two outstanding regulatory breaches to follow up from an inspection on 30 November and 12 December 2016. These breaches were in relation to person-centred care and need for consent.

This inspection was to check improvements had been made and to check whether the conditions on the provider’s registration had been complied with.

Advent House is a two storey purpose built facility which is registered to provide 24 hour accommodation and nursing care for up to 10 people who have a learning disability. At the time of our visit there were four people who used the service permanently and one person who was using the service for respite care on the first day of inspection. At the time of this inspection five people regularly used the service for respite care.

Since the last inspection, which took place on 20 January and 7 February 2017, the provider had appointed a manager, who was on leave at the time of the inspection. The manager was awaiting an interview with the Care Quality Commission in order to become a registered manager. 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.

We saw Disclosure and Barring Service (DBS) Checks were completed. The DBS helps employers make safer recruitment decisions and reduces the risk of unsuitable people from working with vulnerable groups. However, in one file we looked at there were no references. This is a breach of Regulation 19 HSCA 2008 (Regulated Activities) Regulations 2014.

The provider's recruitment policy stated, ‘Employees may be allowed to commence work before a full and satisfactory Criminal Records Disclosure has been received where the Company has received confirmation that the employee is not on the DBS Barred list.’ The policy detailed the safeguards to be put into place in these circumstances. However, DBS guidance states the practice of carrying out a check on the barred list prior to waiting for a full DBS check should only be used as an exception, rather than routinely. We recommend the provider reviews their recruitment policy.

We found the CQC had not been notified of the granting of two DoLS applications in March and May 2017. This was a breach of Regulation 18 CQC (Registration) Regulations 2009 Notification of other incidents. The interim manager retrospectively submitted the notifications and put a system in place to prevent this situation happening again.

We saw improvements had been made since the last inspection. Care records and risk assessments were current and up to date. These were regularly reviewed. Fire drills were regularly completed and a list of staff who attended was kept. This was to ensure every member of staff attended a fire drill on at least an annual basis. We saw evidence in the daily records and people’s activity planners that people enjoyed activities. All staff agreed people now had meaningful activities.

Staff received regular supervision and training. Staff had their competency assessed. We recommend the provider introduces a competency assessment for catheter care and infection control.

There were suf

Inspection carried out on 20 January 2017

During an inspection to make sure that the improvements required had been made

This inspection of Advent House took place on 20 January and 7 February 2017

This inspection was prompted by an incident whereby a person who used the service sustained a serious injury. As this incident may be subject to an investigation the inspection did not examine the circumstances of the incident. However, we did examine how the service managed risk to people in general.

Advent House is a two storey purpose built facility which is registered to provide 24 hour accommodation and nursing care for up to 10 people who have a learning disability. The service is accessible for people with a learning disability and who may need to use a wheelchair. The service is located within a quiet residential area with open views to fields. At the time of our visit there were four people who used the service permanently and one person who was using the service for respite care on the day. At the time of this inspection eight people regularly used the service for respite care.

The service is required to have a registered manager. 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. The service did not have a registered manager at the time of this inspection. The registered manager had de-registered in August 2016; however they continued to work at the service as a registered nurse. The registered provider had deployed an interim manager at the service. A new manager had been appointed in December 2016, but was no longer in post and the interim manager remained in post.

We previously inspected the service on 30 November and 12 December 2016 and at that time we found the registered provider was not meeting the regulations relating to safe care and treatment, person centred care, consent and good governance. We asked the registered provider to make improvements.

At our last two inspections we found risk assessments were not always up to date to reflect current risks to people. This meant staff did not have the written guidance they needed to help people to remain safe. At this inspection we found improvements had not been made.

We found the registered provider had not done all that was reasonably practical to mitigate risks to people and suitable policies were not in place to keep people safe from harm.

We found incidents were recorded but not always analysed for trends, and the registered provider did not maintain an effective overview of incidents to minimise future risks to people.

Emergency plans were not in place in the event of a fire because fire drills had not been regularly completed with all staff to reduce the risks to people.

The above issues were a continuing breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the first day of this inspection CQC issues urgent action to require the service to make improvements. On the second day of this inspection we found the registered provider was taking the required action.

At this inspection we found there were enough suitably trained staff to meet the assessed needs of people who used the service, however nurses didn’t always have time to complete management tasks due to supporting hands on with people with nursing needs.

Staff had a good understanding of safeguarding adults from abuse and knew who to contact if they suspected any form of abuse.

Medicines were managed in a safe way for people.

The provider had not done all that was reasonably practicable to assess, monitor and mitigate risks to people. This was a continuing breach of Regulation 12 and 17 (2) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Effective systems were not in place to assess monitor and improve the quality and safety of the

Inspection carried out on 30 November 2016

During a routine inspection

The inspection of Advent House took place on 30 November and 12 December 2016 and was unannounced on both days. We last inspected the service on 21 July 2016. At that time we found the registered provider was not meeting the regulations relating to person centred care, consent, safeguarding people from abuse, premises safety, staffing and good governance. The service was rated inadequate and placed into special measures and we took action to require the service to improve. The registered provider sent us an action plan outlining the improvements they would make. On this visit we checked to see if improvements had been made.

Advent House is a two storey purpose built facility which is registered to provide 24 hour accommodation and nursing care for up to 10 people who have a learning disability. The service is accessible for people with a learning disability and who may need to use a wheelchair. The service is located within a quiet residential area with open views to fields. At the time of our visit there were four people who used the service permanently and one person who was using the service for respite care on the day. Nine people used the service for respite care.

The service is required to have a registered manager. 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. The service did not have a registered manager at the time of this inspection. The registered manager had de-registered in August 2016; however they continued to work at the service as a registered nurse. The registered provider had deployed an interim manager at the service. A new permanent manager had been recruited, and they commenced employment at the service on the second day of our inspection. They left the service two weeks later and the interim manager remained in post.

At our inspection on 21 July 2016 we found risk assessments for people who used the service were insufficiently detailed. This meant that staff did not have the written guidance they needed to help people to remain safe. At this inspection we found some improvements had been made and risk assessments were in place to provide direction for staff, although risk assessments for one person using the service for respite care had not been updated to reflect current risks.

We found incidents were recorded but not always analysed for trends, and the registered provider did not maintain an overview of incidents to minimise future risks to people.

Emergency plans were not in place in the event of a fire because fire drills had not been regularly completed by all staff to reduce risks to people.

The above issues were a continuing breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.

At our inspection on 21 July 2016 we found the registered provider had failed to ensure suitably qualified staff were on duty at all times because some people who used the service had been assessed as needing nursing care; however there was not always a nurse on duty. At this inspection we found improvements had been made and a qualified nurse was now on duty at all times. We found there were sufficient, suitably trained staff to meet people’s needs.

Safe recruitment procedures were in place, although records were not always available and well organised.

Medicines were managed in a safe way for people.

People’s capacity was not always considered when decisions needed to be made to ensure their rights were protected in line with legislation, for example when deciding to use a night time monitoring device. Evidence of mental capacity assessments and best interest pr

Inspection carried out on 21 July 2016

During a routine inspection

We inspected Advent House on 21July 2016. This was an announced inspection. We informed the registered provider at short notice (48 hours before) that we would be visiting to inspect. We did this because the location is a small care home for people who can be out during the day and we needed to be sure that someone would be in. The service was last inspected in July 2014 and was meeting the regulations we inspected at the time.

Advent House is a two storey purpose built facility which is registered to provide 24 hour accommodation and nursing care for up to 10 people who have a learning disability. The service is accessible for people with a learning disability and who may need to use a wheelchair. The service is located within a quiet residential area with open views to fields. At the time of our visit there were six people who used the service (four permanently and two people for respite care).

The home had a registered manager in place. 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.

The registered provider had failed to ensure that suitably qualified staff were on duty at all times. Some people who used the service had been assessed as needing nursing care; however there wasn’t always a nurse on duty. There had not been a nurse working night duty for two years and more recently some day shifts had not been covered. Insufficient numbers of nurses were employed to cover all shifts. The registered manager told us they would take immediate action and ensure the service was staffed with a nurse at all times.

Risks assessments for people who used the service were insufficiently detailed. This meant that staff did not have the written guidance they needed to help people to remain safe. Staff failed to recognise when incidents would be considered to be abuse and therefore needed referring to the local safeguarding team. This meant that processes were not in place to prevent people who used the service and staff from abuse. Incidents were recorded, however not analysed to reduce the risk of reoccurrence.

Checks of the building were carried out to ensure health and safety, however some water temperatures were low and below the recommended level for the prevention of legionella. There was no evidence to confirm that servicing had taken place on the fire alarm. This meant it may not work properly in the event of a fire, if regular checks are not carried out.

Staff did not understand the requirements of the Mental Capacity Act 2005 and associated codes of practice. Decision specific mental capacity assessments had not been completed and care records did not describe the efforts that had been made to establish that the least restrictive option for people. There were no records to confirm that 'best interest' discussions had taken place with family, external health and social work professionals.

Staff were not trained to care and support people who used the service. Only 11% of care staff employed were qualified in first aid and only 60% of staff had received training around using physical interventions. This type of training needs to be refreshed on an annual basis, however for many staff this was over a year ago. The registered provider told us further sessions had been booked. From a review of the training matrix we found that only 70% of staff had received moving and handling training and only 37% of staff had received training around gastrostomy care. Staff had not consistently received supervisions and appraisals from 2014 to the date of the inspection.

Two of the three care plans we looked at were person centred and included detailed information on how the person needed to be care for. However, for one person the care

Inspection carried out on 24 July 2014

During a routine inspection

At our inspection we gathered evidence to help us 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 the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

Care and support was planned and delivered in a way that was intended to ensure people’s safety and welfare. We looked at two people's care records. We saw these gave detailed information about the person's likes, dislikes and personal family information. The assessments and care plans we looked at were person centred and included people's psychological, physical, social and cultural needs.

Staff were kind and supportive to people; they treated people as individuals. Staff gave good examples of how people were treated with dignity and respect.

We saw that people who used the service were happy and comfortable with staff in their interaction with them. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The Registered Manager set the rotas; they took people’s care needs into account when making decisions about the numbers, skills and experience required. We found there were sufficient staff to meet people’s needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Records showed that one person was currently subject to a DoL’S and the correct procedures had been followed to ensure people’s rights were protected.

Is the service effective?

Staff described how they met and monitored people’s health needs. Care records showed that people had regular contact with health and other professionals.

People’s health and care needs were assessed with them or their representative. Specialist dietary, mobility and equipment needs had been identified where required.

Staff told us they felt well supported to do their job and maintain high standards.

Is the service caring?

We saw that care practices were good. We saw that people were happy, relaxed and comfortable with staff in their interaction with them. There was positive interaction and good eye contact. It was clear that staff were well aware of the needs and wishes of the people who used the service. Staff understood people’s individual ways of communicating their needs.

Is the service responsive?

We saw that people who used the service were responded to promptly when they asked for any support or assistance or gave any indication that they were in any discomfort. It was clear that staff knew the needs of people who used the service very well.

People were supported in promoting their independence and community involvement. People were involved in a number of activities in and outside the home. The home had a sensory room which was clearly enjoyed by people who used the service.

Is the service well led?

Staff said they felt the service was well managed and the Registered Manager was approachable and enthusiastic. They said they had confidence that any issues brought to their attention were always dealt with properly and thoroughly. Staff said they understood their role and what was expected of them.

There was an effective system in place to regularly assess and monitor the quality of the service that people received. We looked at reports and records which showed the provider had assessed and monitored the quality of service provision.