Background to this inspection
Updated
18 November 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 21 and 30 June and was announced. The provider was given 48 hours’ notice because the location was a small care home for younger adults who are often out during the day; we needed to be sure that someone would be in. We visited people on the afternoon and evening of the second day of our inspection so we could see how care and support was delivered at various times of the day.
The inspection was carried out by two inspectors on the first day and one inspector on the second day of the inspection.
We spoke with Mr and Mrs Grimshaw the provider, registered manager and two people who lived at the service during our inspection. The registered manager was on leave on the second day of the inspection. We spoke with local authority contracts and safeguarding officers and we took the information they provided into account when carrying out the inspection.
We read four people's care records. We looked at a variety of records which related to the management of the service such as audits and surveys. We also checked records relating to the safety and maintenance of the premises and equipment.
Prior to carrying out the inspection, we reviewed all the information we held about the home. We did not request a provider information return (PIR) before the inspection. A PIR is a form which asks the provider to give some key information about their service; how it is addressing the five questions and what improvements they plan to make. We also checked whether notifications had been submitted by the provider in line with legal requirements and noted that none had been received.
Updated
18 November 2016
The inspection took place on 21 and 30 June 2016 and was announced.
Mr & Mrs Grimshaw 1 Taylor Avenue, also known as 'Terlyn' is located close to the centre of Ashington and provides accommodation and personal care for up to four people with a learning disability.
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.
The provider was a husband and wife partnership; Mr and Mrs Grimshaw. They employed a registered manager and two staff members, one of whom worked exclusively with one person on a one to one basis outside of the home. There were four people who used the service at the time of the inspection. People told us they were happy with the care they received and had no concerns. The provider and manager described the service as being like a family, and they had supported people for many years and knew them well. We observed positive interactions between the providers and people who used the service.
Safeguarding procedures were in place and staff had received training in the safeguarding of vulnerable adults. People told us they felt safe in the service. A safeguarding investigation was in progress during the inspection and we will report on the outcome once complete.
The manager and provider described in detail the steps taken to ensure the safety of people but this information was not always reflected in documentation, and risk assessments had not been completed in relation to identified risks.
We checked the administration of medicines, and found that one medicine provided by the hospital for one person, was not recorded on medicine administration records (MAR’s). Medicine competency assessments contained insufficient detail, and room temperatures were not taken where medicines were stored. These issues had been addressed by the second day of the inspection.
We inspected records related to the safety of the premises. There was no evidence that a Legionella risk assessment, electrical installations test or asbestos survey had been carried out to demonstrate the safety of the premises. There were no window restrictors on bedroom windows and no risk assessments were in place related to the absence of window restrictors. The provider contacted the local authority health and safety officer for advice. Appropriate fire safety precautions were in place.
Safe recruitment procedures were not always followed. This meant that people were not always protected from potential abuse. We have made a recommendation about this. There were suitable numbers of staff on duty.
The premises were clean and had been recently refurbished. Rooms were nicely personalised and people were involved in decisions about how the home was decorated. Cleaning schedules were in place and people were supported to clean their bedrooms or did so independently.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. We found that capacity assessments had not been fully completed and best interests decisions including decisions related to the management of people's finances were not adequately recorded. Applications to deprive people of their liberty had not been made in line with legal requirements.
Staff had received training relevant to their role, and had received regular supervision and appraisals. There were plans in place to address any gaps in training. Staff had regular opportunities to speak with their manager about any concerns they had due to the small size of the service.
People were provided with nutritious meals and there were new kitchen facilities available. People told us they did not tend to do any cooking as they were out most of the day and one person said that they sometimes helped with cooking. Menus were available but people were able to choose what they ate on a daily basis. Special dietary requirements were recorded and catered for.
People had access to healthcare professionals and were supported to attend appointments in the community or where appropriate, they attended by themselves. People were supported to hospital appointments for reviews of their care and treatment.
People had access to a range of activities and spent most days in the community at day care services, supported employment and social activities. People told us they enjoyed the activities they attended.
A complaints procedure was in place but no complaints had been received by the service. People were encouraged to raise any concerns during house meetings or discussions with staff. The people we spoke with said they had no concerns about the service.
The manager and provider were passionate about the service they provided. There were shortfalls in a number of records including those related to care and treatment, medicines, training, MCA, and recruitment. The provider was proactive in immediately rectifying some omissions following the first day of the inspection and was considering ways in which they could improve their internal quality monitoring systems through linking with other organisations. They carried out audits of medicines and care records.
People were encouraged to be involved in the running of the service and the views of people, relatives and professionals had been sought through feedback questionnaires.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the need for consent and good governance. You can see what action we told the provider to take at the back of the report.