Archived: Independence

The service had a registered manager in place. 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 spoke highly of the service. One person told us, “I feel safe here and I like it.” Another person told us, “It’s nice here; I like my bedroom and the food.” Whilst the feedback from people was positive, we found areas of practice that were not consistently safe, effective, responsive or well-led.

The service was in the process of closing, however, had not formally notified the Care Quality Commission (CQC) neither had they submitted an application to re-register. Due to the process of closing, all paperwork and documentation relating to the running of the service had been archived at another property. As part of the inspection process, this information was requested from archive but was not provided at the time of writing this report. The provider was therefore unable to demonstrate how they were meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014.

People told us they felt safe living at the service. However, risks associated with fire safety, hot water and the premises had not been mitigated. A business continuity plan had not been completed. Lone working risk assessments and policies were not in place. The absence of documentation and paperwork meant the provider was unable to demonstrate how they provided safe care and treatment. People’s ability to evacuate the building had not been individually assessed. We have made a recommendation for improvement.

Systems were in place for people to receive their medicines. However, medicine audits were not completed and the registered manager and director had failed to act upon one person’s medicine being missing from their individual monitoring dosage pack. We have made a recommendation for improvement.

The principles of the Mental Capacity Act (MCA) were not consistently embedded into practice. Systems to identify if people were subject to a Deprivation of Liberty Safeguard (DoLS) were not robust. A staff training matrix was not in place and the provider was unable to demonstrate what training had been provided. We have made a recommendation for improvement.

People spoke highly of the range of meaningful activities that were provided. The director told us, “We are out, more than we are in.” However, daily notes had been archived and the provider was unable to evidence this. Health action plans had not been reviewed or updated in line with people’s change in health needs. Care plans were subject to regular reviews but these were not robust. We have made a recommendation for improvement.

Robust systems to monitor the safety and quality of the service were not in place. Governance systems to identify shortfalls were ineffective and complete, detailed and contemporaneous records were not consistently in place. Feedback was not obtained from people or their relatives and regular audits were not completed.

A range of notices and information was displayed throughout the service but made reference to the service’s old name. These had not been updated or reviewed when the service changed to Independence in 2014. A complaints policy was on display but failed to make reference to the steps required if people were dissatisfied with the outcome of their complaint. We have made a recommendation for improvement.

People spoke highly of the food provided. One person told us, “The food is very nice. I like making cheese on toast and I like salads.” People’s independence was promoted and the principles of privacy and dignity were embedded into practice.

The registered manager and director had spent time building rapports with people. The director told us, “They are like our second family.” Care plans were personalised and provided in picture format. People’s bedrooms were personalised to their tastes and likes. With pride, one person spent time showing us their bedroom and items of importance to them.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.

We looked at the level of hygiene and infection control in the home and found that people were cared for in a clean, hygienic environment.

We examined medicine administration systems and records and found that here were effective systems in place to ensure the safe storage, administration, recording and disposal of medicines.

We looked at three staff files. We found that the home had effective recruitment processes in place. Staff we spoke with felt supported by the management.

We examined systems and records kept by the home and saw that there were good levels of quality assurance monitoring to maintain standards.

We observed staff interacting positively with people. Care plans included detailed advice and guidance to ensure that people's needs were met. Where appropriate, specialist advice and support was obtained to meet people's needs.

There were sufficient numbers of staff on duty. Staff were clear about what they should do if they suspected abuse. There were procedures in place to ensure that anyone wanting to make a complaint could do so.