This inspection took place on 13 and 18 July 2016 and was announced. We last inspected the service on 21 July 2014 when we found the service to be meeting the requirements of the regulations inspected.
Creative Support – Stockport Extra Care Services (Stockport Extra Care) provides care and support to people living in their own homes based within seven extra care housing schemes. The seven schemes were based in the Edgeley, Marple, Reddish and Heald Green areas of Stockport. The registered office for the service is located at Spey House in Reddish. At the time of our inspection the service was providing support to 132 people across the seven schemes.
At the time of our inspection there was 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.
At this inspection, we identified five breaches of three of the regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; the safe management of medicines; taking actions to mitigate potential risks; ensuring the competence of staff; record keeping and effective systems to monitor the safety and quality of the service. You can see what action we told the provider to take at the back of this report. We made one recommendation, which was in relation to ensuring all members of staff receive regular supervision.
There was a reliance on the use of agency staff to ensure the service was able to meet all calls. We found there had been a high number of recent medicines errors by agency staff and there was a lack of evidence to demonstrate the provider’s process for inducting agency staff had been followed. Whilst people told us they were more recently being supported by the same staff on a consistent basis, they also told us they preferred to receive support from regular staff. We saw evidence the provider was actively trying to recruit permanent staff to the service.
People expressed satisfaction with the service they received from Stockport Extra Care and talked positively about the extra care model of care. People told us they felt staff respected their privacy and promoted their independence, for example, by allowing them time to complete tasks for themselves. People told us the permanent care staff knew them and their routines well.
People who had made a complaint told us the Registered Manager had dealt with their concerns to their satisfaction. We viewed records of complaints, which demonstrated complaints had been investigated, appropriate actions taken and a response provided to the person making the complaint. Everyone we spoke with told us they would feel confident to raise a complaint.
We found medicines were not managed in a safe way. Records were not always current or accurate, and there had been a large number of medicines errors occurring in the service. Medicines audits had not been effective at consistently identifying issues or ensuring actions were taken to improve the safe management of medicines. The provider had also identified concerns in relation to medicines and shortly before our visit had requested assistance from their quality assurance team.
We found there was not always evidence that appropriate actions had been taken to ensure potential risks were mitigated following incidents. For example, a risk assessment had not been reviewed following a person sustaining a fall, and another person’s risk assessment had not been reviewed following an incident involving a piece of equipment. The provider took action during our visit to rectify these issues and to improve procedures in place.
We saw staff received training in a variety of areas including safeguarding, moving and handling and dementia awareness. Staff told us the training was of good quality and that they could request to attend training they thought would help them in their role. We saw additional training had been identified by the Registered Manager, including training in pressure care and end of life care, which would help ensure an effective service was provided to people using the service. There were regular checks of staff competence, including checks in relation to specific areas such as maintaining people’s dignity.
Records were not maintained consistently to evidence that people had received the support they required with aspects of care such as repositioning. We were able to cross reference these records to daily notes, which did show people had received the care they required. People told us staff would support them to contact a GP if required and we received positive feedback from a district nurse in relation to the support the service had provided to an individual’s care they were involved in.
Care plans were person-centred and provided the detail staff would require to provide support in accordance with the person’s needs and preferences. We saw care plans had been regularly reviewed and that reviews had involved the person and their relatives where appropriate.
People who used the service and staff told us the Registered Manager and team leaders were approachable and listened to them. Staff told us they felt valued for the work they did and there were regular staff team meetings.