Archived: Smyth House

Smyth House provides accommodation and personal care for up to 18 older people, some of whom were living with dementia. At the time of our visit 12 people were using the service.

What life is like for people using this service:

Risks in the environment had not been identified and acted on. For example, window restrictors were not in place and checks were not carried out to ensure safe water quality. Risk assessments had not been carried out for the staircases in the property. The temperature of the water coming from taps was too hot and posed the risk of scalding.

The service had not identified shortfalls we found and acted upon these, which meant people had been placed at the risk of potential harm. The management had not made themselves aware of Health and Safety regulations and ensured that the service was compliant with these.

Mental capacity assessments had not been carried out and Deprivation of Liberty Safeguards (DoLS) applications had not been made where these would be appropriate.

Risk assessments were in place which set out the measures staff should take to reduce risks such as pressure ulcers, falls or malnutrition. Care planning contained sufficient information about the care people required so staff knew how to meet their needs.

Care records were personalised and contained sufficient information about people’s preferences, specific routines, their life history and interests. People were provided with individualised support to follow their particular hobbies and interests. People made positive comments about the activities.

Improvements were required to end of life care planning to meet best practice guidance such as that provided by the Gold Standards Framework.

People who live at Smyth House have their needs met by sufficient numbers of suitably trained staff.

Staff and the management team were kind, caring and compassionate. People told us that the staff were kind to them and this confirmed our observations.

People were offered a choice of meals which met their nutritional requirements. The risk of people becoming malnourished was identified, monitored and managed.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update):

At the last inspection the service was rated Good. (Report published 7 July 2017)

At this inspection we found there were shortfalls that had not been identified and addressed. This included breaches of regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A registered manager was 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.

At our last inspection 2 and 3 March 2016 we rated the service as overall requires improvement. At this inspection we found that previous shortfalls had been addressed, improvements were ongoing to ensure people consistently received safe, effective, compassionate and high quality care.

People received care and support that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with them in a caring, compassionate and professional manner. They were knowledgeable about people’s choices, views and preferences. The atmosphere in the service was friendly and welcoming.

People were safe and staff knew what actions to take to protect them from abuse. The provider had processes in place to identify and manage risk. Regular assessments had been carried out and care records were in place which reflected individual needs and preferences.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs. Retention of staff was good and supported continuity of care.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with relevant professionals to maintain their health and well-being. Where people required assistance with their dietary needs there were systems in place to provide this support safely.

People and or their representatives, where appropriate, were involved in making decisions about their care and support arrangements. As a result people received care and support which was planned and delivered to meet their specific needs. Staff listened to people and acted on what they said.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). Support workers understood the need to obtain consent when providing care. Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLs and associated Codes of Practice

People were encouraged to maintain relationships that mattered to them such as family, community and other social links. They were supported to pursue their hobbies and to participate in activities of their choice. This protected people from the risks of social isolation and loneliness.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. People’s feedback was valued and acted on. There was visible leadership within the service and a clear management structure. The service had a quality assurance system with identified shortfalls addressed promptly which helped the service to continually improve.

There were 14 people living in the service when this inspection took place on 2 and 3 March 2016. This was an unannounced inspection.

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 the service is run.

People living in the service told us they felt safe and well cared for by the staff. People told us and we observed positive and trusting relationships between staff and people living in the service.

Staff had received training on how to recognise different types of abuse and were confident that if they raised any concerns, appropriate action would be taken.

Individual care records were in the process of being updated to reflect people’s individual needs and preferences. Risk assessments were in place to guide staff on how to minimise risks to people, but some records did not contain paper versions of the risk assessments which could be necessary to prevent delay in the event of an emergency.

There were appropriate arrangements in place to ensure people’s medicines were stored and administered safely.

Safe recruitment procedures and checks were followed to ensure people working in the service were of good character and suitable for the role.

Staff felt well trained to do their job, but had not updated their skills and knowledge in Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training. Staff obtained consent from people before they provided their care, but had a mixed understanding of how capacity was assessed and the consideration of DoLS when a person was receiving medicines covertly.

People were supported to have a varied and balanced diet. Staff knew people’s preferences and were aware of any additional dietary needs.

People were referred promptly to other health professionals when needed, and were often pre-emptive in their approach.

Staff had a caring and compassionate approach to people living in the service and knew them well. We observed positive and respectful interactions between staff and people. People’s privacy and dignity was respected.

People were provided with group activities such as bingo, skittles and entertainers who came into the home. However, further opportunities for additional activities could be developed in future improvement plans following feedback received from people living in the service. We have made a recommendation about meaningful activity for older people.

People living at the home, their relatives and staff alike all thought the home was well led and spoke positively about the manager and staff group. Visitors to the home felt welcomed and always listened to.

Because staff and management knew the people living in the service well, formal resident meetings were not held to encourage people to express their views, however, staff asked for people’s views on an individual basis and people we spoke with felt satisfied with this arrangement.

Relatives told us that they found the registered manager to be approachable and supportive. They set a homely and relaxed culture within the service, however, more robust monitoring and oversight is needed from the management team to ensure the service strived for continual improvement in what it provided to people living in the service.

We observed that staff respected people's privacy and dignity and sought their agreement before providing any support or assistance. The people we saw were relaxed, engaged with their surroundings and interacted with each other.

The people we spoke with told us they were comfortable and liked living in the service. One person told us to, 'Give them 10 out of ten.' Another person told us, 'When it was time, I decided that I needed to come in here and I made the right choice.' People told us that staff always asked their consent before they supported them, one person told us, 'The staff are kind to me, I never have to complain.'

One person's relatives we spoke with were complimentary about the service and said they found that the staff were caring and supportive. They told us that their relative was, "Looking better already.'

We saw that the service had taken precautions to protect people from the risk of infection infection and that staff had received training in infection control and food hygiene.

We saw that the provider had an effective system in place to enable people to make complaints and that they were managed properly.

People who use the service told us they were happy with the way their care needs were met. One said, "I am more than happy with the way I am looked after here." Another said, "All my needs are met." A member of staff was spoken to and they were able to demonstrate an understanding of the assessed needs of the people who use the service.

We examined the service's policies and procedures relating to safeguarding and found that people who use the service were protected from the risk of abuse

We tracked the care records of four people who used the service which showed that people experienced care, treatment and support that met their needs and protected their rights.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.