Palmer Crescent

We found the following examples of good practice:

There were enough staff to meet people's needs and the provider had contingency plans to cover unexpected staff absences, such as those due to isolation because of COVID-19.

There were a number of staff vacancies at the time of our inspection which meant agency and bank staff were used regularly. The registered manager had minimised the impact of this on people’s care by using regular bank and agency staff and ensuring they worked alongside permanent staff to understand people’s needs.

People who lived at the home were supported to access testing for COVID-19 and to have their COVID-19 vaccinations. Best interests procedures had been followed where people lacked the capacity to give informed consent to these interventions. People who had contracted COVID-19 during the pandemic had been supported to self-isolate in their bedrooms.

Staff had weekly PCR tests and a LFD test every day they worked. An assistant service manager (ASM) maintained a testing tracker for staff. Only staff who had been fully vaccinated against COVID-19 were permitted to work at the home. Staff who contracted COVID-19 during the pandemic did not return to work until they had completed an appropriate period of self-isolation.

The service enabled visiting to take place safely. Visitors were required to answer COVID-19 screening questions, have their temperature taken and provide evidence of a negative LFD test. Professional visitors also had to demonstrate their COVID-19 vaccination status.

Visits were planned to ensure there were never multiple visitors in the home simultaneously. When visiting had not been possible during the pandemic, staff had supported people to keep in touch with their families and ensured people’s relatives were kept up to date about their family member’s well-being.

The premises were clean and hygienic. The registered manager said additional cleaning had been implemented, including cleaning of frequently-touched areas on each of the three shifts a day. Standards of IPC were checked and monitored. One member of staff had been appointed as IPC champion and taken on monthly IPC audits. Staff had access to the PPE they needed and had attended training in its use.

Staff had supported people to access healthcare services if they needed them. The registered manager said the service had received good support from the local health centre during the pandemic, which enabled people to access any care and treatment they needed.

The registered manager said they had received good support from the provider during the pandemic, including regular updates on government guidance when this changed frequently. The provider had a contingency plan which includes measures to manage any further COVID-19 outbreaks.

Risk assessments had been carried out to identify and manage any risks to people who lived at the service and staff posed by COVID-19.

People’s experience of using this service:

People were supported by consistent staff who knew them and their needs well. Permanent staff were supplemented by agency staff who worked at the home regularly. Staff communicated effectively with one another about people’s needs and accountability for people’s care had improved.

Opportunities for people to go out and to take part in activities had increased. This included day centres, in-house activities and leisure activities, such as eating out and shopping.

The leadership and management oversight of the service had improved. The registered manager and assistant service managers (ASMs) provided good support to staff and maintained an effective oversight of the service.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

There were enough staff on each shift to meet people’s needs and keep them safe. The provider’s recruitment procedures helped ensure only suitable staff were employed. Staff had the induction, training and support they needed to carry out their roles. They understood their roles in keeping people safe from abuse and felt able to speak up about any concerns they had.

Potential risks to people had been assessed and measures put in place to mitigate these. If accidents or incidents occurred, staff took action to reduce the risk of similar incidents happening again. Medicines were managed safely and staff maintained appropriate standards of hygiene and infection control. Staff supported people to maintain good health and worked effectively with any professionals involved in their care.

Staff were kind treated people with respect. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

At the last inspection the service was rated Requires Improvement. The report of this inspection was published on 30 June 2018.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Palmer Crescent accommodates up to 24 people in four bungalows on one site, each of which has separate adapted facilities. The registered provider of the service is Welmede Housing Association Limited, part of the Avenues Group, which specialises in providing care to people with learning disabilities or autism.

There was no registered manager in place at the time of our inspection. The previous registered manager had left their post at the beginning of February 2018. A new manager had been appointed and was due to take up their post the week after our inspection. 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’s cluster manager told us the new manager would apply for registration with CQC.

We found there was an over-reliance on agency staff which affected people’s experience of care. There was a high number of vacancies on the permanent staff across the four bungalows. The provider had maintained the staffing levels needed to keep people safe but the high use of agency staff meant people were often supported by staff who did not know them well. Relatives told us that it was important for their family members’ well-being to be supported by familiar staff who knew their needs well. They said the high use of agency staff was discomfiting for their family members. The high number of vacancies also placed pressure on the remaining permanent staff. They were working hard to ensure people received the care they needed but some staff were working excessive hours.

Shortages of permanent staff also affected people’s opportunities to take part in activities. There were not enough authorised drivers employed to take people to some of their planned activities and staff had to prioritise taking people to medical appointments. This meant that some people’s identified needs were not being met.

Following our inspection the provider’s regional manager acted promptly to develop an action plan to address the concerns we had identified. This plan set out how the consistency of care people received would be improved and how permanent staff would be supported. Actions included allocating experienced staff from elsewhere in the organisation to support the service until new permanent staff could be recruited and block-booking agency staff to ensure that regular agency staff were employed.

Risks to people’s safety were identified and action taken to keep people as safe as possible. Accidents and incidents were reviewed and measures implemented to reduce the risk of them happening again. Health and safety and fire safety checks were carried out regularly to ensure the home was safe and well maintained. The provider had developed a contingency plan to ensure that people’s care would continue in the event of an emergency. The bungalows were suitably adapted and designed to meet people’s needs. Adaptations and equipment had been installed where necessary to ensure people were able to mobilise safely.

Staff were recruited safely. The provider obtained evidence from agencies that the temporary staff supplied had undergone appropriate pre-employment checks. Staff understood their responsibilities in safeguarding people from abuse and knew how to report any concerns they had. People received their medicines safely and as prescribed. Staff maintained appropriate standards of hygiene and cleanliness and followed safe infection control procedures.

People’s needs had been assessed before they moved into the home to ensure staff could provide the support they required. Staff had the training and support they needed to carry out their roles effectively. Staff attended an induction when they started work and had access to ongoing training. Specific training was provided if people developed needs that required it. The provider checked that agency staff had attended training relevant to the roles they performed.

People’s rights under the Mental Capacity Act 2005 were respected. Staff understood the importance of gaining people’s consent to their care and how people communicated their decisions. People who lacked capacity received appropriate support when decisions that affected them were made. Applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe,

People were able to make choices about the food they ate and were supported to maintain a healthy diet. Staff ensured that individual support guidelines around diet and nutrition were followed. People were supported to maintain good health and to obtain treatment when they needed it. Each person had a health action plan which detailed their health needs and the support they needed.

Staff treated people with respect and maintained their dignity. They respected people’s individual rights and promoted their independence. People were supported to make choices about their care and to maintain relationships with their friends and families.

Care plans had been developed where needs had been identified during assessment. These were personalised and provided guidance for staff about how care should be delivered. They also outlined what people could do for themselves and how staff could support them to be independent. The provider had established people’s preferences about their end of life care to ensure their wishes would be respected should they become seriously ill.

There were appropriate procedures for managing complaints. Relatives told us that any concerns they had raised had been listened to and acted upon by the provider. Checks on the management of were included in The provider’s quality monitoring audits checked that any complaints received an appropriate response.

Relatives told us the provider communicated openly with them. They said the previous registered manager had always been available if they wished to discuss their family member’s care with them. Relatives told us the regional manager had listened to their concerns about the high use of agency staff and how this affected their family members. They said the regional manager had made them aware of the plans in place to address this issue.

People who lived at the home, their relatives and other stakeholders had opportunities to give their views about the service. The provider’s quality monitoring systems included auditing important areas of the service regularly and action plans were developed when shortfalls were identified.

We identified two breaches of the Health and Social Care Act 2008. Further information is in the detailed findings below.

We visited each of the three bungalows and spoke with one relative, six staff and the registered manager.

We asked a relative who was visiting if staff gained consent for their daughter's care. They told us that they were involved in decisions about their daughter's care and, 'If my daughter didn't want to do something she wouldn't'.

We made a visual inspection of the premises and noted that people's rooms were clean and tidy, and communal living areas, kitchens and bathrooms, were clean and well maintained.

We spoke with staff about staffing levels as there had been concerns during our previous inspection. Most staff told us, 'Things are much better now'. On the day of our visit we saw that there were sufficient staff to provide the care that people needed.

A relative told us that they had no cause for complaint but knew who to speak to if they did. We saw that the provider logged complaints and responded to them appropriately.

We looked at people's care records, staff records and other records and saw that these were complete, reviewed regularly and up to date.

One person told us they had "Never been more pleased with the home" and that staff had a good understanding of people's needs.

We saw that each bungalow was staffed with a team leader and two care staff. There were two absences due to staff sickness in two of the bungalows on that day where other staff had to be called upon to work to cover the absences. Staff told us that there were persistent problems with staffing and covering when people were absent due to illness.

During the inspection we saw that most people took part in a music activity which everyone appeared to enjoy. We observed that staff interacted well with people during this and encouraged people to participate.

We saw three care plans where only one was up to date. Only one had an up to date risk assessments. Staff told us that care plans and risk assessments were not up to date because they had not had the time to do them.

During our inspection we saw several examples of staff acting in a caring and supportive manner.