7 and 11 January 2016
During a routine inspection
The inspection was carried out on 7 and 11 January 2015 and was unannounced. The service provided accommodation and personal care for up to ten people with a moderate to severe learning disability. Nine people were living at the home on the days of our inspection.
The accommodation was spread over three floors and each person had their own spacious bedroom with either a sink or ensuite facilities in the room. A patio garden was available for people to use with a small pond area.
There was a registered manager employed at the service. 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.
Recruitment records were not adequate to keep people safe from receiving care from unsuitable staff.
The provider was not following systems and processes in order to monitor the quality and safety of the service.
On going supervision and appraisal of the registered manager was not maintained to enable them to carry out their role effectively. Staff appraisals were not carried out on an annual basis as stated in the providers supervision policy.
People and their relatives told us they felt safe at the home and knew who they would speak to if they had concerns. A safeguarding procedure was in place and staff knew what their responsibilities were in reporting any suspicion of abuse. Staff could describe how to recognise the signs of abuse and were aware of the importance of their role in keeping people safe.
Effective management of risks kept people safe without impacting on their independence. Plans were in place with safety measures to control potential risks. Risk assessments had up to date information for staff to follow as they were reviewed regularly.
Fire prevention and safety was well thought out and managed. All maintenance and servicing checks were carried out, keeping people who live at the property safe.
There were enough staff on duty to support people with their assessed needs and to make sure they were able to go out and about following their many interests. This was evident by our own observations as well as feedback from people, their relatives and others.
Appropriate training had taken place for staff and the most important training courses were being updated.
People’s medicines were managed safely by a registered manager and staff team who were trained and competent. All medicines recording and storage was well ordered, providing safe and effective practice.
The home had a lovely atmosphere, friendly and relaxed. People and staff were comfortable together, joking and having lots to talk about. People, their relatives and others we spoke to thought the staff were caring and patient and had a very good approach.
The staff had worked hard finding activities for people to do to suit their individual interests. People were out doing something every day, mainly travelling on public transport. Staff had supported people to write a CV in order to look for work and five people had found volunteer positions.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and staff showed that they understood the Mental Capacity Act 2005 and DoLS. The registered manager understood their responsibilities as Mental Capacity assessments and decisions made in people’s best interest were recorded.
People were given choices and supported to make their own decisions on a daily basis. Relatives were involved in decision making where appropriate.
People liked their food and so this was an important part of their day. People were fully involved in the shopping, choice and decision making when it came to meals.
People and their family members were involved in the assessment of their needs before moving into the home. Support plans contained very detailed person centred information and guidance. All aspects of a person’s health, social and personal care needs were included to enable staff to meet their individual requirements. Personal life histories gave a really good understanding of the person as an individual for any new staff. There was a real emphasis on maintaining and increasing independence. This was highly evident when spending any time within the home
People’s privacy and dignity were respected by staff who could describe what this meant. People’s bedroom space created an air of their individual personality and a sense of personal privacy.
Family members and friends were welcome at any time and they tended to know all the other people living in the home and vice versa.
Complaints were taken seriously and acted upon. People and their relatives confirmed this, we saw where the registered manager and the provider had responded to issues raised.
Accidents and incidents were recorded on the providers on line system and followed up by the provider so lessons could be learnt.
We have made a recommendation about staff annual appraisals.
We have made a recommendation about the registered manager’s supervision and annual appraisal.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.