Archived: Cherry Tree Housing Association - 5 Tavistock Avenue

5 Tavistock Avenue is a small residential care home providing a care for up to three people with a learning and or physical disability. At the time of our inspection three people were living at the home. One person had recently been moved to the service from another service managed by the provider. This was to enable them to carry out some essential maintenance and refurbishment of the other property.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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’s relatives told us that the care and support provided at the home was appropriate to meet their needs. However we found that people did not always receive the support they needed to access or engage in meaningful activities outside the home. Staff told us that there were not enough staff available to support people to meet their individual needs. Some activities had been provided on a planned basis, but this was limited to the availability of staff. People were provided with a choice of food and drinks. People were supported to access healthcare services to help maintain their health where appropriate.

There was a robust recruitment process in place to help ensure that staff were of good character and suitable for the roles they performed at the service. However the process for completing similar checks for agency staff were less robust.

People were able to communicate with us in a limited capacity but indicated that they felt safe living at the home. Risks to people’s safety and wellbeing were managed. However versions of peoples risk assessments were not always dated. People’s medicines were managed safely. Staff had received training in safeguarding people from potential abuse and were able to tell us the process for reporting concerns.

Staff had received training to help them to provide safe support for people however, for some staff the training had expired and they required refresher training. There were no assessments undertaken to assess the knowledge and competencies of the staff team.

Staff felt supported by the management team, and the new registered manager was in the process of introducing new systems and processes to help ensure support arrangements were more consistent. Staff had completed training in relation to the Mental Capacity Act 2005 (MCA) but were not always clear on their responsibilities and people’s rights under the Act.

Record keeping was not always robust. Peoples care records did not always demonstrate that people were involved in the planning and making decisions about how and when their care was provided. People’s dignity was not always respected or considered. Care records were not always dated and there were several copies of similar documents so we could not tell which the current care record was. Reviews were also not consistently completed and where changes had happened, care plans and risk assessments did not always reflect the changes.

There were no recent quality monitoring records and the provider’s systems were not robust and had not identified shortfalls we found during our inspection. The registered manager had only been working at the service for a short time and had identified some areas which required improvements. However these had not yet been implemented.

There were no systems in place to obtain regular feedback from people who use the service. Although people were invited to individual reviews of their care, it was not evident that anything changed as review documents recorded ‘no change’. Meetings were not held to enable people the opportunity to discuss the wider issues in a supported group environment and so did not empower people.

Relatives of people who used the service told us that they felt the home was generally well run. However there had been several changes of management which meant there was a lack of a consistent approach to managing the service.

The last inspection was undertaken on 22 and 28 September 2015. We found that the service required improvement in the safe and well led questions. The provider sent us an action plan detailing how they would be making the required improvements.

We inspected 5 Tavistock Avenue on the 28 September and 5 October 2016 and found that there were areas of improvement still required, particularly in relation to how the quality of the service was monitored and also in relation to record keeping.

The home did not have a registered manager in post. The registered manager had left the service six weeks before the inspection commenced. There was a new manager who was in the process of registering with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 this inspection we found there were not sufficient numbers of staff deployed to provide care safely to people living in 5 Tavistock Avenue. The manager had not informed us about incidents that required reporting which is required to help keep people safe from the risk of harm. People were supported by staff who had undergone a recruitment process to ensure they were suitable to work in a care setting. However, there were inconsistencies in the recruitment of staff depending on when they were recruited. We saw that when agency staff were used the manager did not always complete the same level as robust checks as they did for permanent staff.

Risk assessments were completed and reviewed to help staff to manage risks, although, the records were not always updated to reflect the current position. People’s medicines were managed safely and there was a process in place to for the safe ordering, storage and disposal of people’s medicines.

Staff did not feel supported by the manager and felt that they were being criticised about how the service operated. Staff had received some training but some of the refresher updates had not been provided. We saw there were arrangements in place for staff to have an induction when they commenced their employment to help support them to carry out their roles effectively.

People’s nutritional needs were met and their food and fluid intake and weight were kept under review. People were able to choose what they ate from the menu. However, the menu being updated at the time of our inspection as the new manager felt that more ‘healthier options’ should be introduced.

People told us they were supported to maintain their health and well- being and had access to a range of health professionals. We saw that people had a purple folder which contained a summary of healthcare appointments and records of key events.

Staff spoke with people in a kind, caring and compassionate way. We observed good interaction between staff and people and relatives confirmed this to be the case.

People’s dignity and was privacy was maintained. However, people did not always get choices about how and where they spent their time.

People did not always receive care that was responsive to and met their needs. Although staff were aware of people’s individual needs and how to meet these, due to management changes they were not always able to accommodate people’s needs and wishes. People were provided with some opportunities to participate in activities mainly in the community. People were supported to spend time in their own home; however people and staff told us that they had recently had to visit another home in close proximity to spend time there.

There was a complaints policy and procedure in place and we saw evidence of one complaint had been responded to by the manager. However the process had been long winded and protracted and had taken four months to get a conclusion.

People did not always receive care that was well led and that was monitored appropriately. People’s care plans were regularly reviewed, however, the plans did not always identify changes to people’s needs. Audits were not effectively reviewed to ensure actions were completed, and notifications were not consistently sent to CQC when required.

During our inspection on 24 January 2014, we met all three people who used the service. People we spoke with were very happy with the care and support they received and told us they liked living there. One person told us: "I like it here'. Another person told us: 'I am happy here'.

Overall, care plans we looked at provided adequate guidance to staff to help them meet people's care and support needs safely.

Staff we spoke with told us they had received the training they needed to meet people's care and support needs. However, staff training records we looked at showed that some people had not received refresher training on some topics, including refresher training to protect vulnerable adults from abuse and to ensure staff's safe practice relating to the administration of people's medication.

People we spoke with told us that they felt safe living in their home and knew who to talk to if they had any concerns. There was a complaints system in place which showed that any concerns people, or their family members, had about the service were addressed.