Ayeesha-Raj Care Home

Updated 26 June 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection was carried out by one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.’ Their area of expertise is dementia care.

Service and service type:

Ayeesha-Raj is a care home. People in care homes received accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service did not have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

This inspection was unannounced. The Inspection site visit took place on 23 May 2019.

What we did:

We used information we held about the home which included notifications that they sent us to plan this inspection. We also used the completed Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We used a range of different methods to help us understand people’s experiences. People using the service were not able to talk with us in detail about their care experiences, so we spoke with two relatives. We had discussions with six staff members that included the operations manager, the acting manager and four care and staff support.

We reviewed care plans for three people to check they were accurate and up to date. We also looked at medicines administration records and reviewed systems the provider had in place to ensure the quality of the service was continuously monitored and reviewed to drive improvement. These included accidents and incidents analysis, meetings minutes and quality audits.

Updated 26 June 2019

About the service:

Ayeesha-Raj Care Home is residential care home registered to provide personal care for up to twenty people living with a learning disability and whose behaviours may be challenging. At the time of our visit there were thirteen people using the service.

People’s experience of using this service:

There had been a lack of managerial oversight in relation to systems in place to monitor the quality of the service. For example, quality checks on people’s medication, infection control and care plans had not identified areas that required actions to be taken.

People’s communication needs, although identified had not been met, for example, there was a lack of information in different formats to meet their communication needs. People were not always supported to have maximum choice and control of their lives and staff (did not support) supported them in the least restrictive way possible; the policies and systems in the service did not always support this practice.

Satisfaction surveys were completed but we could not be assured these reflected the views of people, and we were not able to see how comments made were used to improve the service.

Although the service was clean in most areas we found some areas were not clean and safe from the risk of infection. The premises needed some refurbishment and redecoration. Following the inspection, the operations manager sent us a refurbishment plan to show that on-going repairs were being carried out and future plans for redecoration.

People’s everyday medicines were managed safely, but some ‘as needed’ medicines did not have guidance for staff to follow. Improvements were required to the mealtime experience for people using the service.

Care plans were personalised and provided staff with sufficient guidance about how to support people. These were reviewed monthly, but improvements were needed to the review process.

There were effective systems in place to safeguard people from abuse. The risks to people’s health and wellbeing were assessed and action taken to reduce them.

There were enough staff deployed to keep people safe. People were involved in the recruitment process and all the necessary employment checks had been completed to ensure only suitable staff were employed.

People had an assessment of their needs before they went to live at the service to make sure their needs could be fully met. Staff received an induction and ongoing training and felt well supported through the systems in place for one to one supervision.

People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

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.

Staff were calm, kind and caring and we observed that they knew people well. There was a ‘link worker’ system in place so that people had a staff member allocated to them to provide any additional support they may need.

There was a complaints policy in place and concerns were discussed with people at house meetings. The registered manager was aware of their responsibility to report events that occurred within the service to the CQC and external agencies.

The service met the characteristics for a rating of "requires improvement" in all five key questions when we inspected. Therefore, our overall rating for the service after this inspection was ‘requires improvement’.

Rating at last inspection: Good (The date of the last report published was 8 November 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement:

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to Good Governance. Details of the action we have asked the provider to take can be found at the end of this report.

Follow Up:

We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services

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