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Archived: Blakenhall Resource Centre Inadequate


Inspection carried out on 22 and 24 October 2014

During a routine inspection

At our previous inspection on 1 April 2014 the provider was not meeting the law in relation to the care and welfare of people using the services, the management of medicines and the assessing and monitoring of the quality of service provision. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made.

This inspection took place on 22 and 24 October 2014 and was an unannounced inspection.

Blakenhall Resource Centre provides long term and short term accommodation and care for up to 29 older people who have mental health needs. There were four people living at the home on a long term basis and four people living at the home on a short term basis when we inspected.

The service had a registered manager, as required by the terms of its registration. 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. At the time of our visit the registered manager was on a long term absence and the service was being managed by a temporary care manager since September 2014.

People and their relatives gave mixed views about their experiences of the service. Some relatives and people told us they were happy with the service. However, other relatives raised issues with us. This included one view that a person’s health and well-being had deteriorated since their time at the service and that this was due to poor care. Other relatives told us they felt poor morale among staff was affecting the standard of care. While we observed some improvements since our last visit on 1 April 2014, we identified a number of concerns with the service.

We found that inadequate responses had been made to an incident involving a person falling. This included a failure to ensure their environment was safe and that staff had updated guidance on how to support them safely. We saw that risk assessments were not consistently updated to reflect the current risk to people’s safety and well-being.

We found some improvement in the completion of people’s medication administration records. However, we found further concerns around the administration of ‘when required’ medicines, the storage of medicines and the records maintained for people. Controlled drugs were appropriately stored and recorded.

We found there were adequate staff available to support people.

Staff knew how to identify abuse and to report it. However, we were aware of safeguarding matters that should have been reported to the local safeguarding authority, but were delayed.

Staff had poor knowledge of Deprivation of Liberty Safeguards (DoLS) and gave inconsistent answers about people who were subject to a DoLS. This meant there was a risk that people’s rights would not be appropriately supported.

We found that there had been improvements in the provision, monitoring and recording of fluids given to people to drink. People’s cultural preferences around food were respected.

We found that there were gaps in some areas of staff knowledge and training. Issues of performance had not always been addressed with staff by the management team.

We found staff assisted people in a caring and compassionate way. However, we observed that staff missed opportunities to interact with people more frequently in order to improve their experience of the service.

Not all relatives felt that staff listened to them when they explained the needs of people living at the home.

The personalisation of care plans had improved since our last visit. However, some care plans contained contradictory information about people’s needs.

We saw some activities being provided to some people which met people’s interests. However, we also saw examples of people not receiving stimulation during our inspection.

Visitors to the service told us they were welcomed by staff, which meant that people were able to maintain relationships which were important to them.

The provider had a robust complaints procedure. People had access to information about how to make a complaint.

We found a number of issues which the provider’s own audits had failed to identify. We found examples of the provider not implementing the action plan they had submitted to us following our last visit. We also found that the provider had not implemented advice given by the local Clinical Commissioning Group (CCG) who buy and monitor health and social care services.

The provider had failed to notify us of issues which it was required to do so by law. The provider had also failed to send us information it we had requested within a specific timescale. The information requested was a ‘Provider Information Return’ in which the provider is asked to describe how they are meeting current legislation in the provision of care.

We found that the provider had not fully met the action plan they had sent to us. We also found a number of additional issues during this visit. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 1 April 2014

During a routine inspection

We carried out this inspection so that we could answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection as people were unable to share their views with us. We spoke to a relative, three members of staff who supported people, a visiting social worker, health colleague, area manager and looked at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that systems were in place to ensure managers and staff could learn from events such as accidents, incidents and complaints.

The systems however were not always successfully highlighting potential risks to people. We found gaps on the medication administration records, where staff had not completed them appropriately when they administered people's medicines, and the audit system that was being used by managers did not pick this up. The provider's medication policy was also not being followed by staff, when administering "As required" medicines which could potentially put people at risk.

There was a procedure to follow when someone had a fall, however the process was unclear as to when staff would seek medical intervention where people were found on the floor.

We found that there was sufficient staff on shift, however we did not see people having regular access to fluids. We observed one person being supported to have a drink late into the afternoon. This highlighted concerns as to how frequently people were able to access fluids to reduce any potential risk of dehydration.

No applications for the Deprivation of Liberty Safeguards had been submitted by the service. The staff we spoke with were able to explain when an application would need to be made to ensure people's safety.

Overall we found that the provider did not have adequate processes and systems in place to ensure people were cared for and supported in a way that kept them safe. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affect people's safety.

Is the service effective?

We found that a sensory garden was in place so people could use the garden safely at their own leisure. People were able to access health professionals as required. A relative told us they felt their relative was being cared for appropriately.

We found that the provider had systems in place to ensure people's needs were being assessed and any changes to people�s needs could be identified and actioned appropriately.

Is the service caring?

Our observations were that people were being supported by staff who were caring and supportive. We saw staff spending time talking with people. We saw staff supporting people to draw and paint at their own leisure. People were also supported to go out on trips outside of the home as part of people receiving regular social interaction.

Records showed that satisfaction surveys were being used to gather the views of people or their representatives where people were unable to share their views. The information gained was then used to improve the service people received.

Records showed that people�s likes and dislikes, preferences, interest and cultural and religious needs were recorded appropriately to meet the requirements of the law in relation to ensuring that the service was caring.

Is the service responsive?

A relative we spoke with told us they knew how to make a complaint. We saw evidence of complaints that had been received by the provider and the action taken. This meant that complaints were being actioned appropriately as a way of improving the service to people.

People were unable to access drinks on a regular basis. This meant that the service was not responsive to the needs of people to ensure their safety. We have asked the provider to tell us what improvements they will make in relation to being responsive to people's needs.

Is the service well-led?

We found that the service worked in partnership with NHS colleagues who were based on the same site and shared resources as required. We spoke to a health colleague on site who was currently developing a falls prevention course to support staff knowledge, skills and understanding in reducing the risk of falls within the centre.

The staff we spoke with had a good understanding of the various quality assurance systems in place, and were able to confirm that audits were being completed regularly. The audits being done were ineffective as we found evidence of gaps in paperwork. We found that there was a complaints process in place so people and their representatives could share any concerns.

We have asked the provider to tell us what improvements they will make in relation to being responsive to people's needs.

Inspection carried out on 3 October 2013

During a routine inspection

During our inspection we spoke with four people, a visiting professional and four members of staff, including two senior staff. We looked at six people�s care records.

We found that people gave their consent for care. Where people were not able to express their consent the home had made provision for their best interests to be considered. However, we did find there was sometimes a lack of records to demonstrate consent for some people.

The care people received was reflected in their care plans. One person told us, �They give you time and have the ability to look after you well�.

People were provided with drinks to keep them hydrated throughout the day. One person told us, �I get plenty to drink�. We found that appropriate food to support people�s health was available.

We saw that there was enough staff to meet people�s needs. Staff had the right skills to support people safely.

The provider carried out audits to ensure people were safe and received a quality of service.

Inspection carried out on 28 December 2012

During a routine inspection

During our inspection we spoke with four people, three relatives, four members of staff and two visiting medical professionals. We looked at four people�s care records.

We found that people were supported in making day to day decisions about the care they received. People�s values and diversity were respected and promoted.

The care people received was reflected in their care plans. Care plans were kept updated. One person told us they, �Couldn�t do better�. People�s safety was promoted, but staff had not received recent training in dealing with behaviours that challenge.

We found that the premises were safe and well maintained. The proper use of fire doors was not always respected.

We found that staff were recruited in a safe way and correct checks were carried out to ensure their suitability to care for people. One person described staff as, �Marvellous�. We found some gaps in staff training.

The service had a clear complaints procedure which was accessible to people so they would know how to make a complaint if they chose to.

Inspection carried out on 6 March 2012

During a routine inspection

We could not speak with some of the people who lived at or were staying at the Centre because of their needs. We did have lots of interaction with people and observed how staff communicated and interacted people. We spoke with the staff and some of the visitors.

We observed some positive interactions between staff and people staying at the centre. However we saw some examples where people were not involved in decisions, such as when staff turned on music without asking people whether they wanted it on.

We saw that everyone had a written care plan. There were a range of risk assessments in place which meant staff were aware of how to minimise dangers presented to people. Information from visitors and staff suggested that relatives or significant others had been involved in agreeing their care plans. These were kept under regular review. Staff were knowledgeable about people�s individual care needs.

We saw that the quality of care was reviewed by the manager, but further work in this area was required to show that systems were in place to monitor and assure themselves that they met the law.

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