The Care Quality Commission

Archived: 1 Saint Anne's Road

1 Saint Anne's Road, Exeter, Devon, EX1 2QD (01392) 436536

Provided and run by:
Alias Choice Limited

All Inspections

13 September 2012

During an inspection in response to concerns

We carried out this inspection because concerns were raised about people's safety when incidents occurred between two people who used the service. We wanted to make sure that care workers had the skills, guidance and support necessary to keep people safe and protected. We saw that risk assessments had not been carried out following recent incidents. We also checked that effective measures were in place to minimise the risk of further incidents occurring. Although staff had been instructed on measures these were not recorded anywhere.

Our inspection lasted approximately four and a half hours, and was carried out by two Compliance Inspectors. There were three people living in the home at the time of our visit. There had been no registered manager employed in the home for more than two years.

Two care workers were on duty in the home when we arrived. The deputy manager was not on duty that day but she visited the home shortly after our arrival after being contacted by telephone by a care worker to advise them of our inspection.

One person said they were happy living in the home and said they felt safe. They told us they were confident they could raise any concerns with the deputy manager or any of the care workers. Another person said they were happy living in the home, but also described some incidents when they had been sworn at, and when they had been concerned about the possibility of harm.

During our visit we observed the care workers interacting with the three people living while they were having their evening meal. The care workers were attentive and supportive towards the three people and treated people in a friendly and respectful manner.

We found that people were not fully protected from the risk of harm or abuse. There was no registered manager employed at the home. There were no clear lines of delegation or accountability to ensure that records relating to people's care and safety needs were updated regularly. Care workers had received verbal instructions to supervise two people closely at all times when they were both at home. However, we heard that this may not always be possible, especially during the periods when there was only one care worker on duty.

After our visit we spoke with the provider on the telephone. They gave us assurances that they would take actions to address the issues we found.

23 May 2012

During an inspection looking at part of the service

We (the Care Quality Commission) carried out an unannounced inspection at

1 St Anne's Road on 23 May 2012. The purpose of this inspection was to review the actions taken by the provider to address compliance actions issued following inspections of the home on 14 January 2011, 31 May 2011 and 3 November 2011. The compliance actions related to '

Outcome 2 - Consent to care and treatment

Outcome 7 - Safeguarding people who use services from abuse

Outcome 9 - Management of medicines

Outcome 14 - Supporting staff

Outcome 15 - Statement of purpose

Outcome 24 - Requirements relating to registered managers

During this inspection we also looked at outcomes -

Outcome 4 - Care and welfare of people who use services

Outcome 10 - Safety and suitability of premises

Outcome 13 - Staffing

Outcome 16 - Assessing and monitoring the quality of service provision

Outcome 17 - Complaints

At the time of this inspection there were three people with learning disabilities living in the home. When we arrived there were two people at home.

During our visit we talked to two people who lived there, and also the acting manager and two care workers. We looked at care plan files, daily reports, records of medicines administered, staff training, staff supervision, staff meetings, staff rotas, maintenance records, fire safety records, resident's meetings, policies and procedures, quality assurance, records of accidents and incidents, and complaints. We also looked at issues relating to the management of the home. We carried out a tour of the premises. Before, and after, our visit we talked to a social care professional, and also to the manager of the local Learning Disabilities Team.

We talked to two people about their daily lives. They told us about things they enjoyed doing and people who were important to them in their lives. We saw care workers talking to them in a friendly and respectful manner. The care workers were able to demonstrate a good understanding of people's likes and dislikes and personalities. We asked people if they liked living at the home. One person who had communication difficulties did not respond to this question. The second person talked about some of the things that sometimes upset him, and also described the things he liked about living at 1 St Anne's Road.

We found that people had not been fully consulted or informed about their care. There was no evidence of people being given a copy of their care plan in a format they could understand, or to show they had contributed to the content of the plans or agreed to the content. Risks to people's health, safety and well being had not been fully recognised, and the care workers had not received sufficient guidance, training, support or supervision to enable them to support people at times when they may be distressed or angry, or when they may pose a danger to themselves or other people.

In a tour of the home we found that essential repairs and maintenance had not been carried out in a timely manner. A leaking shower had caused a hole in the sitting room ceiling. The leaking shower had been reported in the maintenance book five times since February 2012 but no action had been taken to repair the leak or the damage to the sitting room ceiling. Since the visit the provider has confirmed that a builder has begun to address maintenance issues highlighted in this report.

We also saw areas of the home that had not been redecorated for many years and where the decoration was in need of attention. A settee in the sitting room was torn and damaged and the carpet in this room was threadbare in one area and badly stained. Bedroom flooring was damaged and torn.

There were six care workers employed to work in the home, and this included a care worker who was temporarily acting as manager. The care workers said they had been working longer hours than they had been originally contracted to work in order to cover vacant posts. This meant that there was limited capacity among the staff team to provide cover for any unexpected leave or sickness. The acting manager said they had attempted to appoint a further member of staff in March 2012 but the provider had not applied for a Criminal Records Bureau check and therefore the person was not appointed.

Care workers had only received one formal supervision session in the last year. The acting manager had not received any formal supervision. Staff meetings were held regularly.

The home's Statement of Purpose and their Service User Guide had not been updated and included references to outdated legislation. The information had not been provided in alternative formats to ensure that people who had difficulty reading had information about the home in a format they could understand.

There were inadequate systems in place to assess or monitor the quality of the service. Regular meetings were held in the home with people who lived there, and these meetings had been minuted. However, where matters had been identified that required action, there was no evidence to show that these had been considered, or any plan put in place to address them. Other areas covered in this report, including maintenance of the home, care planning, staff training and supervision, and complaints had not been included within the quality assurance system.

Records of complaints made by people living in the home showed that their concerns had not been adequately investigated, and action had not been taken to address the issues or to prevent recurrence. This showed that people may have been at risk of abuse or harm through failure of the home to consider the potential implications of the complaints. The home's complaints policy was displayed on the notice board in the dining room. However, some information in the policy was out of date. The policy was in small print, and there was no information about complaints or safeguarding available in alternative formats suitable for people who had difficulty reading text.

There had been no registered manager in post since June 2010. At the time of this inspection a care worker who had worked in the home for a number of years had been given the role of acting manager. They told us they did not want to take on the role of registered manager.

We asked the provider to send us information to help us make a judgement on the standards that we looked at during the visit to the home. We communicated with the provider by telephone and by e mail. Where we have had a response we have added to the report.

We concluded that people who lived at 1 St Anne's Road had not received adequate care and support to keep them safe and to meet all of their care and welfare needs.

19 January 2012

During an inspection looking at part of the service

We (the Care Quality Commission) carried out this inspection to follow up on the provider's compliance with two Warning Notices. We had issued the Warning Notices following a review of the service in November 2011.

One Warning Notice related to Regulation 21, Outcome 12 'Requirements relating to workers'. The other Warning Notice related to Regulation 10, Outcome 16 'Assessing and monitoring the quality of service provision'. We also made compliance actions relating to other outcome areas.

We made an unannounced visit to the home which lasted approximately seven hours and thirty minutes. During the visit, we collected sufficient evidence to judge that the provider was compliant with two other outcomes, where there had been non-compliance on our last visit. This was with regard to Outcome 10 'Safety and suitability of premises', and Outcome 20 'Notification of other incidents'.

Three people were living at the home when we visited, although one of them was not at the home on the day. We met the other two people, one of whom was not able to answer our questions in detail because of their communication needs. Staff helped us in getting some of their views, and we observed some of the support they received. Both people went out to the cinema in the afternoon, supported by staff. We spoke with the two staff on duty. The acting manager, who was not on duty, was informed of our visit and came to the home later in the morning.

One person who lived at the home confirmed that they were asked for their views of the service at residents' meetings. They also told us they would speak with the acting manager if they had a request or a concern, because she 'follows things up.' They described repairs to their environment that had been carried out or which were due to happen. They indicated such matters were important to them and they were pleased about the action taken.

Minutes of residents' meetings showed that each person's views had specifically been sought, on certain aspects of life at the home. Where someone was less able to respond verbally during these meetings , their body language had also been noted. There was evidence that people's requests had been followed up, such as for a particular meal or attention to the environment.

People indicated that the staff were respectful and ensured their privacy, which we observed during our visit. One confirmed they felt they were treated equally to other people who lived at the home.

3 November 2011

During an inspection looking at part of the service

There were three people living at the home on the day we visited it. We were assisted throughout the day by the two staff on duty and by the acting manager, who came to the home on her day off to assist us.

Two people who lived at the home, who were able to speak with us to give us their views, confirmed they were given choice in their daily lives. They said they felt staff supported them to make decisions. During our visit, we heard all three people being encouraged to make decisions about how they used their time. We also found that people's consent was sought by staff. However, there was a lack of records to show that individuals were giving valid consent, as there were no proper assessments of people's mental capacity. Such assessments would help to show, for example, whether or not someone understood what care or treatment they were consenting to.

We saw people living at the home approached staff freely, sometimes engaging very cheerfully or at length with them. They received a supportive response from staff. People told us that they got on with the staff and felt safe with them. Those who could not give us their views in detail seemed at ease with the staff on duty, moving around the home as they wished and communicating readily with others. They had all been on holiday recently, which the manager said almost all of which had been paid for by the service.

People confirmed that they felt able to speak to the staff if they were unhappy about something and that they would be listened to. However, we found people were at risk because some risks of harm or abuse were not responded to appropriately by the service. And they were not protected against the risks of inappropriate care because there was no effective monitoring of the quality of the service or of risks to people at the home. For example, there were insufficient measures in place to identify issues with management of their medication. Neither had some environmental risks been identified or managed appropriately. We had not been informed of all important incidents that affected people using the service.

Because the provider does not always operate effective recruitment procedures, people were not protected from unsuitable staff. We also found that staff did not receive appropriate training, supervision and appraisal relevant to their responsibilities.

We read in people's care records that they had been involved in some gardening at the home. Those who spoke with us with were pleased with recent improvements at the home such as repainting of communal areas. They said that most repairs were attended to in a timely way.

1 June 2011

During an inspection looking at part of the service

We found the care plans for people living at the home reflected their current needs and preferences. They felt they received support they needed from staff and were given enough choice in their daily lives, being supported to make decisions for themselves. We noted that records did not always include information about individuals' capacity to make decisions for themselves in different situations.

People were happy with how their medication was dealt with by staff, and their care records showed that they were enabled to receive support from relevant professionals for their various health needs. We found that their suggestions for other activities and life skills goals had been followed up. Thus people were being supported and encouraged to develop or learn new skills, and enjoy new positive experiences. They told us about some of the activities they had enjoyed in the last fortnight, such as days at a local Theme Park and the Devon County Show, a trip to the cinema, a weekly art group, and swimming.

All those living at the home seemed very at ease with the staff on duty, approaching them to speak about various matters and having conversations with them. People moved freely and independently between the shared areas of the home and their own rooms during the day.

Staff were aware of local safeguarding processes, although there was no current guidance available at the home to ensure people continue to be protected from the risk of abuse. Other relevant professionals had been involved when people living at the home were affected by certain events, though we had not been informed of these incidents.

People were pleased that the environment was now brighter and fresher due to redecoration, and some action had been taken to address the damaged flooring noted at previous visits. There was a lack of systems to ensure the continued hygiene of the premises, or the ongoing upkeep of the decor and furnishings.

Training for staff had been greatly increased, although support for staff was still not always sufficient to ensure they would be enabled to continue to suppport people appropriately.

Overall, the quality of the service was not being assessed and monitored effectively enough to ensure that people received appropriate care. However, people's personal records were accurate and kept securely, with other records showing attention to safety in the provision of the service.

14 January 2011

During a routine inspection

People living at the home told us about opportunities to be involved in the running of the home. They felt they could say what they thought, and thought they were given enough choice in their daily lives.

There was evidence that the service supports individuals who make lifestyle choices that place them at risk, working with the person and other relevant professionals to minimise the risks. People felt supported by staff to make decisions for themselves, as we saw during our visit. Staff have also been involved in multi-agency 'best interest' decision-making in relation to people living at the home who did not have the capacity to make certain decisions. However, the rights of people who live at the home might not be upheld because robust systems were not in place for gaining and reviewing valid consent.

People said they could see their doctor when they wanted, and felt the home looked after their health. Although the two people we pathway-tracked did not have health care plans or care plans updated to reflect their health needs, people told us about routine health checks they had.

People were happy with how their medication was dealt with by staff. They may not have their medication needs met safely, however, because the service does not handle medicines appropriately.

It was clear that people were able to do some activities and pastimes that they particularly enjoyed. But we also found that suggestions for other activities or courses, holidays, and life skills goals had not been followed up. Thus people were not being supported and encouraged to develop, learn new skills, enjoy new positive experiences, etc.

We saw that people's bedrooms were personalised with their own possessions, reflecting their interests, life histories, etc. People told us they were happy with their own room and the facilities in general (the heating, lighting, hot water, etc.). One person told us how they altered their radiator setting to suit themselves.

The accommodation is not being maintained in ways that ensure it is safe and promotes people's wellbeing. People told us they had noticed the mildew stains evident in bathrooms, caught their slippers on torn flooring in the kitchen, and found the uneven floor in a corridor slightly alarming as it upset their balance a bit. There has been no routine checks of fire safety systems for some months, though people told us the fire alarms were sometimes triggered by the laundry machines. They are not instructed on what to do in the event of a fire.

Two people who were able to go out independently felt there were enough staff around on a daily basis. We saw other people received support in a timely, unhurried way, and staff spent one-to-one time chatting with them, etc. However, people may not have their needs met by competent staff as the provider does not ensure that all staff are properly trained, supervised and enabled to acquire further skills relevant to the work they undertake.

There is no effective monitoring of the quality of the service people receive to ensure they are protected against the risks of inappropriate care and support. People told us staff had carried out a survey with them. We saw this had been done in the last year. They said some of their suggestions had not yet been acted on. People's personal records were not always accurate, fit for purpose, or kept securely, whilst other records required to be kept for their benefit were not always maintained.