Archived: Derriads

This inspection was unannounced and took place on 13 September 2017

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.

Systems were in place to manage risk. The staff we spoke with knew the actions needed to protect people from the risk of potential harm. However, risk assessments were not in place for all risks identified. For example, moving and handling. While staff reported accidents and incidents the reports were not analysed to identify patterns and trends.

We found areas of the home needed repairs, flooring in some areas such as the foyer was heavily soiled and there was poor storage for equipment. Although the registered manager had reported the repairs, action was outstanding.

The principles of the Mental Capacity Act (2005) were not consistently followed by the staff. People’s capacity to make complex decisions was not assessed. We saw people were under continuous supervision and staff confirmed this but Deprivation of Liberty Safeguards (DoLS) were not considered or applied for. Staff had not considered that lap belts and bed rails were forms of restrictions and had not assessed this.

Care plans were generally person centred. For some people their life stories lacked detail such as education and the events that led to their admission. Person centred profiles for some people were brief and lacked detail. For example, future goals.

Systems in place to assess and monitor the quality of the service needed to improve. People’s views about the service or those people close to them were not gathered. While audits had identified similar shortfalls to the inspection findings action had not been taken to make improvements.

When we asked one person if they felt safe they agreed and said “yes”. However, people using the service at the time of the inspection were not able to tell us what feeling safe meant to them. Staff said they attended safeguarding of vulnerable adults training. Records confirmed this. The staff we spoke with knew the types of abuse and the expectations that they report abuse.

The staff we spoke understood the importance of developing positive relationships with people. Staff were knowledgeable about people’s likes and dislikes. We saw people accept staff support and there were good humoured interactions between people and staff.

Medicine systems were safe. Staff signed medicines administration records (MAR) charts to show the medicines that had been administered. Protocols were in place for medicines to be administered as required.

There was a system in place to determine the number of staff required for people on respite care. Staffing levels had improved with recruitment of new staff but there was a reliance on relief staff to cover absences and vacant posts.

Members of staff received effective support to meet their roles and responsibilities. New staff received an induction for the role they were employed to perform. Mandatory training set by the provider was attended by all staff to ensure they had the skills needed to meet people’s needs. Group supervision was monthly and staff had the opportunity to discuss work issues and changes in policies were shared. One to one supervision with the registered manager was on request by staff or by the registered manager to discuss performance.

Some people attended day care services during the week and at weekends, staff organised outings and in house activities.

We found breaches 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.”

We found that significant improvements had been made which had also benefitted employee's within the whole of Wiltshire Council.

A wide range of documentation around safeguarding vulnerable adults and whistleblowing had been devised to ensure that people who used services, their families and staff had access to appropriate information. A whistleblowing poster, a revised policy and a new leaflet for people who used the service had been written. The leaflet was written in easy English with pictures, which explained how to tell someone if you were being treated unfairly. Staff would now be able to use the leaflet with people, if anyone who stayed at Derriads had a concern around being safe. The revised whistleblowing policy had more information so that staff knew who to contact if they had a concern.

The training department in Wiltshire Council had changed the way they provided training in safeguarding, so that there was more face to face training. Staff said they preferred this method as it was easier to understand. We spoke with one agency worker who told us they had received refresher training in safeguarding and they had found the 'face to face learning better than just learning from a computer'.

The department who supplied agency and relief agency staff to services such as Derriads had put a new system in place to ensure that all staff who worked for the council, were competent and knowledgeable in safeguarding procedures and were able to support people appropriately.

During our visit we spoke with three members of staff who worked in the home. We also spoke with the acting manager and team leader. People who were currently staying at the home for respite care were not able to fully verbalise their experiences of their stay at Derriads. We observed their care and found that there were positive interactions between people and staff. We spoke with a relative of one person who regularly stayed at the home for respite care.

Staff were knowledgeable about supporting people to make choices and we saw many examples throughout the day where this was the case. A care worker told us "It is really important that you involve people, even if it's just putting a tea bag in a cup it is an achievement which should be encouraged'. Staff were aware of what constituted a healthy balanced diet and we saw that people were encouraged to make healthy food choices.

We saw that the home had sufficient suitable equipment which was well maintained. This included ceiling hoists which were available in all of the bedrooms and in the main bathroom. The home involved other professionals in people's care such as podiatry and occupational health and staff said that they had a good relationship with the different health and social care agencies.

We looked at the systems in place within the home and spoke with representatives of the Governance, Training and Relief agency departments within Wiltshire Council. We found that people were not fully protected against the risks of abuse as the quality assurance systems in place were not fully effective.

The home was clean and warm with adequate ventilation and had been decorated throughout with neutral colours. Each of the bedrooms were furnished and people could bring in their own personal items when they stayed for respite.

The home had a policy on staff recruitment and induction. Staff said they had completed a Criminal Records Bureau (CRB) check when they had been offered the appointment and that their references had been followed up prior to the interview. Information was available to people and their families on how to make a complaint, we also saw that information was available about advocacy services. We looked at the last complaint made and found that it had been fully investigated and resolved to the satisfaction of the person and their family.