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Auckland House Requires improvement

Reports


Inspection carried out on 8 May 2019

During a routine inspection

About the service: Auckland House is a residential care home for people living with a learning disability, autistic spectrum disorder or mental health need. The service was a large home, bigger than most domestic style properties. It was registered to support up to eight people. Eight people were using the service at the time of the inspection. This service is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were no identifying signs, to indicate it was a care home. Staff did not wear anything that suggested they were care staff when coming and going with people.

People’s experience of using this service:

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; people’s abilities, needs and mental capacity were not always assessed to ensure they had as much choice and control as possible. We have made a recommendation about the management of some medicines, reviewing current guidance and the application of the Mental Capacity Act (2005).

People told us they were safe at the service. Risk management required improvement to ensure risks to people had been identified and assessed. The Mental Capacity Act (2005) had not always been applied to decision making where appropriate.

Person centred care was promoted in the service and people experienced positive outcomes, however people’s support plans did not always reflect all their needs and goals to support the delivery of person centred care.

Quality assurance processes were in place but had not identified some of the concerns we found. The registered manager took prompt action to address these shortfalls and ensure actions for improvement were added to their action plan for the service.

There was a positive culture in the service and staff were supported through training, supervision and team meeting to provide effective care for people. People told us staff were kind and caring and were treated with dignity and respect.

Rating at last inspection: This service was rated Good at the last inspection and the report was published on 21 October 2016.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will follow up on our recommendations at the next scheduled inspection. We will continue to monitor the service through the information we receive.

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

Inspection carried out on 13 September 2016

During a routine inspection

The inspection took place on the 13 September 2016 and was unannounced.

Auckland House provides care and accommodation for up to eight people. On the day of the

inspection eight people were living in the home. The service provides care for people with a learning

disability.

The manager had undertaken their interview with the Commission in August 2016 to be the registered manager, and they have been advised their certificate will be issued shortly. 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.

Following an inspection in July 2015 we asked the provider to take action to make improvements which related to records, notifications and quality assurance. At this inspection, we found the necessary improvements had been made.

The service provided good care and support to people allowing them to lead fulfilled and meaningful lives. The interactions between people and staff were positive. We heard and saw people laughing and smiling. People looked comfortable, relaxed and happy in their home and with the people they lived with. Relatives were welcomed into the home and had clearly formed positive and trusting relationships with the staff team.

There was a positive culture within the service. The manager said, “As well as being the manager I like to work with people. I enjoy spending time with the staff and people we support”. Staff had a good understanding of people’s needs and spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people’s needs and to keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe. Staff were trained and aspects of training were used regularly when planning care and supporting people with their needs and lifestyle choices.

People were supported by staff who had a good understanding of how to keep them safe. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm.

Staff encouraged people to be independent and promoted people’s choice and freedom. People moved freely around the building and its grounds and the community as they chose.

Care records contained detailed personalised information about how individuals wished to be supported. People’s individual methods of communication were taken into account and respected. People’s risks were well managed, monitored and regularly reviewed to help keep them safe.

People were supported to take part in a range of activities both inside and outside in the community.

People had their medicines managed safely. People were supported to maintain good health through regular access to health and social care professionals, such as GPs and speech and language therapists. People’s dietary needs and any risks were understood and met by the staff team.

The manager and staff demonstrated a good understanding of the Mental Capacity Act 2005. People were supported to make everyday choices such as what they wanted to eat and how to spend their time. The manager was aware of the correct procedures to follow when people did not have the capacity to make decisions for themselves and if safeguards were required, which could restrict them of their freedom and liberty.

The manager was aware that notifications about important events to CQC had not always been made and since joining the home in December 2015 had been making notifications when needed. The manager had just become aware of DoLS requests having been made in 2015 and agreed to notify CQC as soon as possible.

Staff described the management as supportive and approachable. Staff talked positively about their work and comments included, “It’s a good place to work, the team are committed to meeting the needs of the people who live here”. Staff were well supported through induction and ongoing training.

The service had an open door policy. People’s relatives opinions were sought through surveys and there were effective quality assurance systems in place that monitored people’s satisfaction with the service. Timely audits were carried out and investigations following incidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the service.

Inspection carried out on 23 July 2015

During a routine inspection

This unannounced inspection took place on 23 July 2015.

Auckland House is a service which provides support and accommodation for up to eight people who live with a learning disability. At the time of our inspection there were eight people living at the service.

The service had 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 registered manager did not work day to day in the service and undertook a senior management role. The provider had appointed a new manager (referred to throughout this report as the manager) who had been in post for three weeks at the time of our inspection and who worked day to day in the home. They were supported by a deputy manager and senior support worker. They told us they planned to become the registered manager in the near future.

People told us they felt safe at the home and staff had a good understanding of their roles and responsibilities in protecting people from abuse. They knew what to look for and the action to take if they were concerned, however not all incidents had been reported to the local authority and to us.

Staff were aware of risks associated with people’s care and knew the action to take if the risks presented. Incidents and accidents were monitored and used to inform the delivery of care. Medicines were stored securely and administered as prescribed. However temperature checks of medicines storage did not consistently take place.

Staffing levels were sufficient to support people safely and in a calm, professional manner. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed. Staff received training and supervision to make sure they had the skills and knowledge to support people.

Staff were aware of the need to gain people’s consent and to respect the decision they made.

Where people lacked capacity to make certain decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs. People were supported to access healthcare services as they needed.

People had developed good relationships with staff who were kind and caring in their approach. People were treated with dignity and respect. Staff actions promoted and encouraged people’s independence. They were encouraged and supported to be involved in making decisions about their care and day to day life. Plans of care for people were individualised and staff responded to people’s changing needs.

The home had an open, friendly atmosphere in which people were encouraged to make their views and opinions known. The manager was new in post and told us they operated an open door policy and encouraged staff and people to make suggestions or discuss any issues of concerns. They were spending time getting to know the provider’s systems, people and staff. Staff felt unable to comment about the new manager as they had not had time to get to know them however, staff were confident the senior management team were approachable and always available if they needed support or guidance.

The manager was not aware of any recent complaints at the time of our inspection and none had been recorded in the complaints files. We were not confident that staff always recognised when a person was raising issues that should be addressed under the complaints procedure. We have made a recommendation about this.

Not all records were complete and an accurate reflection of people’s support needs. Some health conditions that presented risks did not have plans in place which guided staff. Where best interests decisions had been taken, staff had not ensured records were held of these and where DoLS had been approved these were not reflected in peoples plans of care.

Systems were in place to monitor the quality of the service but these were not always fully effective in identifying areas where improvements were required. Not all incidents that required notifying to CQC had been reported. Policies were not reflective of current legislation. We have made a recommendation about this.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the HSCA 2008 Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 17 July 2014

During a routine inspection

During our visit we spoke with four people who lived at the home, and two relatives on the telephone. We spoke with the registered manager and three members of staff. We also spoke with a local authority care manager, community psychiatric nurse (CPN), and the local safeguarding team.

We used this visit to answer our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

Three of the people we spoke with had no concerns about the support they received. People and their relatives told us about their satisfaction with the home and told us they felt safe. A relative told us, �They care for my relative; even when they are challenging. I have no worries about their safety.� We saw that care and treatment was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had assessment tools in place to assist staff in establishing the level of risk for people.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us staff had received training with regard to DoLS; and the home was working with the local learning disabilities team on a DoLS application for one person. We saw there were suitable arrangements to ensure people were protected from the risk of abuse.

There were arrangements in place to deal with foreseeable emergencies. The service had a business contingency plan to deal with any short or long term emergencies such as loss of electrical power or loss of gas supply. The home was working on a contingency plan should the home become uninhabitable and people could not return to the home after an evacuation.

Is the service effective?

Each person had a plan of care and support; these explained what the person could do for themselves and what support they needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We observed staff supporting people. The care staff we spoke with were aware of people's needs and people's preference in how they wanted their care to be delivered. We saw staff offer advice and support and enabling people to make their own choices and decisions.

Is the service caring ?

We saw people being treated kindly and with dignity and respect by the registered manager and staff. Care workers spent time chatting with people and responded promptly to people�s request for assistance. Staff had a good understanding of people�s needs. People described their satisfaction with the home. One person told us, "I like it here. The staff are brilliant.� Another person told us, �Staff are always nice and polite � Everybody gets treated the same way.�

We heard staff speaking to people appropriately and staff using people�s preferred form of address. Most of the people we spoke with told us the staff� were kind and patient in their approach.

Is the service responsive?

Staff responded promptly to peoples request for assistance. People had regular reviews of the care and support they received and care plans showed alterations had been made to people�s plans of care as people�s needs had changed. We saw people were able to participate in a range of activities. Staff told us they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service, their relatives, and staff were asked for their views about how the home was meeting people�s needs and any concerns or ways to improve the service were acted on.

Is the service well led?

A relative we spoke with told us they had regular contact with the home and said they could speak to the manager or staff at any time. They told us they were kept informed about any issues which affected their relatives.

All of the staff and people we spoke with said they felt supported. We saw the home had systems to monitor and assess the quality of the service provided by the home. These included the service manager conducting a number of monthly audits including health and safety inspections of the property, people�s care records, and staff training and supervision.

Staff meetings took place monthly and minutes of these meetings were kept. Staff we spoke with confirmed this and said the staff meetings enabled them to discuss issues openly with the manager and the rest of the staff team.

Inspection carried out on 16 October 2013

During a routine inspection

We spoke with five people who used the service to obtain their views on the service provided. All of the people we spoke with told us they were happy at Auckland House and said that staff treated them well. We also used other methods to help understand people's experiences. These included; observing how staff supported people, talking to staff and looking at records.

On the day of our visit the registered manager was not available and we were supported by a senior member of the care staff who was able to provide us with good information about the service provided at Auckland House.

We also spoke with three members of staff. They said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were supportive and approachable.

Inspection carried out on 21 January 2013

During a routine inspection

We spoke with six people who lived at Auckland House. Due to the nature of people�s learning disability we were not always able to ask direct questions to people. We did however chat with them and were able to obtain their views as much as possible. We also used a range of methods to help us understand people�s experiences. These included; observing how staff supported people, talking to staff, talking to people who used the service and looking at records.

People we spoke with told us they were happy at the home and that staff treated them well. They said that they felt safe at the home and if they had any concerns they would speak with a member of staff.

We also spoke with two relatives of people who told us that they were very happy with the care and support their relatives received. They said that they were consulted about the care and support their relative received and were invited to reviews of their relative's care. Comments included: �The staff always keep me informed of any changes and my relative is happy at Auckland House�.

Relatives told us that they knew how to make a complaint and said they were confident that any complaints would be dealt with appropriately.

We spoke with three members of staff. They said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively.

Inspection carried out on 28 October and 4 November 2011

During an inspection in response to concerns

We spoke to all seven of the residents at the home. They told us that they were very happy with the care and support that they were receiving. They told us about the staff and their key workers. They said that the staff were �very nice and kind.�

People told us that their privacy and dignity was respected. They said us that they liked their bedrooms and the food was nice. People told us that they enjoyed the meals and they could choose something different if they did not like what was on the planned menu.

People said that the staff supported them to access the community and told us about the varied activities that they took part in.

Reports under our old system of regulation (including those from before CQC was created)