Archived: Acash Lodge I

At the time of our inspection there were four people living there permanently. Additional people stayed at the service on a short term basis to enable family carers to have a break. This is often referred to as a respite break.

The service was a terraced house, on three floors with a front and back garden.

We previously inspected the home on 17 May 2016 and we found the provider was in breach of standards relating to the safe care and treatment of people using the service. We also made a recommendation in relation to training.

There was no registered manager in place at the time of the inspection, however a manager had started in post in January 2017 and was applying to be the registered manager. 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 last inspection we found staff were not always following procedure in relation to completing body maps. Body maps are diagrams used to assist staff in recording unusual or unexplained marks on people’s bodies. At this inspection we found that staff were routinely completing body maps and taking appropriate action in notifying relevant organisations if there were issues of concern noted.

There was a relaxed atmosphere at the service on the day of the inspection. We saw kind and caring interactions between staff and people living at the service.

The service was clean but we found one out of date meat products in the fridge which was removed immediately. There were repairs outstanding on the day of the inspection but the provider has since repaired these.

Recruitment checks were in place for the majority of staff prior to them starting work at the organisation. There were enough staff to meet people’s needs although there had been a number of staff changes in the last nine months which impacted on the quality of the service.

Care plans were up to date and there were risk assessments in place for people living at the service. The manager was in the process of updating the risk assessments for people who used the service on a respite basis.

People’s money was safely managed.

Medicines were stored securely, within appropriate temperature range and administered safely.

Staff received regular supervision and had undertaken training in key areas to support them in their caring role.

Quality audits were undertaken. These included health and safety, cleaning, medicines and finances management.

We have made a recommendation in relation to staff recruitment.

We undertook this unannounced focused inspection of 17 May 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this matter. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Acash Lodge I on our website at www.cqc.org.uk. Acash Lodge I is a care home registered for a maximum of six adults who have a learning disability.

At the time of our inspection there were four people living there permanently. Additional people stayed at the service on a short term basis to enable family carers to have a break. This is often referred to as a respite break.

The service was a terraced house, on three floors with a front and back garden.

Since our last inspection a registered manager had been recruited. 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 last inspection we found staff were not receiving regular supervision and had not been trained in all the key areas to support them in carrying out their role safely. At this inspection we found that staff had either completed training or were booked onto training in the majority of the key areas. There were some areas such as Makaton training (a communication tool that some people with a learning disability use) and use of a specific medicine for epilepsy that were still outstanding.

At the last inspection we found that the service was not always using ‘body maps’ effectively in care records. Body maps are diagrams used to assist staff in recording unusual/unexplained marks on people’s bodies. At this inspection we noted that whilst one body map had been completed correctly and acted upon appropriately for a person who was using the service for respite, another body map for the same person had been filed away without any investigation of the mark taking place. This was of concern as it was not clear how the marks noted on the person’s body had occurred.

At the last inspection we found that staff recruitment processes were not always thorough. Disclosure and Barring Service (DBS) checks were completed (to check whether a person had a criminal record) but not all references had been received prior to staff being employed by the service. At this inspection we found that references had been received for three new staff employed since our last inspection, and other checks had been carried out. These were important to ensure staff were considered safe to work with people living at the service.

At the last inspection we found care records were individualised but risk assessments for people using the service for respite care were not always up to date. Care records for people using the respite service lacked detail to ensure their needs could be met. At this inspection we found that the care records for people using respite had improved and the majority had up to date risk assessments on file. However, there were some that had not been updated in the last year , although their needs had not changed since they were written.

At the last inspection we found that whilst people had their prescribed medicines managed safely, the use of non-prescribed medicines, called ‘homely remedies’ needed to be formalised. There was a person who was routinely being given a homely medicine without any formal authorisation. At this inspection we found that provider had introduced a homely medicines policy, and there were no regular homely medicines given without a prescription from the GP.

We found the provider was in breach of standards relating to the safe care and treatment of people using the service.

We have also made a recommendation in relation to training.

You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection there were four people living there permanently with short term respite placements offered to a number of people who live in the community who use the service on a regular basis.

The service is located in a terraced house, on three floors with access to a front and back garden.

We previously inspected the service on 4 September 2013 and the service was found to be meeting the regulations inspected.

Acash Lodge 1 does not currently have a registered manager in post. 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 day to day running of the service was being managed by the deputy manager (who also had a caring role) and the provider.

During the inspection people were calm and there was a pleasant atmosphere and we observed good quality interactions between staff and people using the service, and people were being treated with dignity and respect

Care records were individualised but risk assessments for people using respite were not always up to date. Care records for people using the respite service lacked detail to ensure their needs could be met.

People were supported to maintain good health through regular access to health and social care professionals, such as GPs and the local community learning disability team.

People were promoted to live full and active lives and were supported to access activities in the wider community if they wished. People’s cultural and religious needs were actively facilitated by staff.

People had their medicines managed safely. People received their medicines as prescribed and on time. The use of non-prescribed medicines, called ‘homely remedies’ needed to be formalised.

Staff recruitment processes were not always thorough. Disclosure and Barring Service (DBS) checks were completed but not all references had been received prior to staff being employed by the service.

Staff felt supported and talked positively about their jobs. We saw that staff were caring. However, we found no evidence of regular supervision taking place. Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. But there was not sufficient evidence to confirm staff had received sufficient training in key areas.

There were enough staff to meet people's needs on the day of the inspection.We were not able to evidence how staffing levels were calculated when there were additional people using the service for respite.

The home did not have comprehensive arrangements for quality assurance. Some audits and checks had been carried out by the acting manager but there was no evidence of audits in relation to care records and the last audit of all medicines was in March 2015.

We found the premises were clean and tidy and the building was maintained and decorated to a good standard. There was a record of essential servicing of gas, electricity and fire safety equipment and maintenance was carried out. There was documentation relating to complaints and incidents.

Management of money for people using the service was administered well.

The building was not suitable for people using the service or visitors with significant mobility problems. This was not an issue for the people who used the service at this point in time as nobody had any mobility problems.

We have made recommendation about the management of some medicines and recruitment practices.

We found breaches of the regulations in relation to care records and staff support and training.

You can see what action we told the provider to take at the back of the full version of the report.

Peoples choices and preferences were respected by staff.

People who used the service told us they liked the service. One person said they had been helped by the staff at the home, enough to ask to move into supported living accommodation. One visitor who spoke with us said they were very happy with the home and their relative enjoyed coming back to the home after being away with their family.

We found that peoples care needs were assessed and plans put in place to manage their needs, which included managing any potential risks to their safety and well being.

Staff had training in relation to safeguarding vulnerable adults and had access to information to guide and support them in this area.

People receive their medicines in accordance with their prescribed needs. There were effective arrangements in place to management of the different types of medicines used by the residents.

We spent time with or spoke with four of the people who lived at the home, and one relative visiting a person living at the home. People living at the home had complex needs which meant that some of them were not well able to tell us their experiences.

Four staff members were on duty at the time of the inspection. The home was decorated for Christmas, and appeared bright and cheerful. The majority of people living at the home were in the lounge area. One person in particular enjoyed the music played, and staff encouraged them to dance from time to time, which they clearly enjoyed.

People appeared to be well supported within the home. They indicated that they were provided with the care that they needed, had opportunities to carry out activities, and had formed good and supportive relationships with staff members.