Background to this inspection
Updated
24 April 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 9 and 16 March 2018. The inspection carried out on 9 March 2018 was unannounced. However, the inspection carried out on 16 March 2018 was announced.
The inspection visit was carried out by one inspector.
Before the inspection visit we looked at all the information we held about the service. This included notifications of significant events and the last inspection report.
During the inspection we met with two people who lived at the home. Communication was however limited. We therefore observed how they were cared for and supported by care staff. On the first day of our inspection, the operations manager was not present. We therefore spoke with two care support staff on the day. The consultant and director of the service were unable to attend the home on the first day of the inspection. People in the home had plans to go out and therefore nobody was present during the afternoon. We therefore went back to the home on 16 March 2018 to complete our inspection. On the second day of the inspection the operations manager, consultant and the director were present. We also spoke with one senior care staff and two care staff.
During the visit we looked at the care plans and records for two people, records of staff recruitment for two members of staff, support and training documentation, accidents, incidents and other records the provider used for monitoring and managing the service. We also looked at the environment and how medicines were managed and stored.
Updated
24 April 2018
This inspection took place on 9 and 16 March 2018. New Beginnings Residential Care - Harrow View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were two people who had learning disabilities living in the home.
Our previous inspection on 7 March 2017 found three breaches of regulation and made one recommendation. We rated the home as “requires improvement”.
The first day of our inspection was unannounced. On this day we observed that two people were in the home and there were two care staff on duty. However, there was no manager on duty. As a result we went back to the home on 16 March 2018. The second day of the inspection was announced.
This inspection on 9 and 16 March 2018 found that the provider had made improvements to the home and care provided. However, we found that that there was a lack of consistent management presence in the home.
There was no registered manager in post at the time of this inspection. 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 and associated Regulations about how the service is run.
Our previous inspection found that there were some aspects of the care provided that were not safe. We previously found that fire safety arrangements were not adequate and we found a breach of regulation in respect of this. During this inspection in March 2018, we noted that the home had taken action in respect of this and had implemented fire safety checks and staff had received the necessary training.
Our previous inspection also found that medicines were not stored appropriately and we found a breach of regulation in respect of this. During this inspection, we noted that the home had made improvements in respect of this. However, we observed that there were two errors on one MAR chart we looked at for the day of the inspection. We raised this with the operations manager and she advised that she would speak with the member of staff concerned.
Accidents and incidents had been recorded. However, we noted that the remedial action following the incident was not documented. It was therefore not evident what the service had done to prevent the reoccurrence. We made a recommendation in respect of this.
We looked at the staffing rota and noted that it did not accurately reflect the staffing arrangements in the home. For example; the rota stated that the operations manager would be working from 9am to 5pm on the first day of our inspection. However, this was not accurate as the operations manager was away on leave. We were therefore not satisfied that management were always deployed as required to meet people’s needs and we found a breach of regulation in respect of this.
Risk assessments had been carried out which detailed potential risks to people and how to protect people from harm.
Our previous inspection found that people’s care plans lacked information about what support people required and we made a recommendation about this. During this inspection, we noted the home had made improvements. They had implemented a new format support plan for people which included information about what support people required as well as how they wished to be supported with various aspects of their daily life.
Our previous inspection found that there were significant gaps in staff training and a lack of appraisals and we found a breach of regulation in respect of this. During this inspection, we noted that the home had made improvements and staff had completed the necessary training and where required they had received an appraisal.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Our previous inspection in March 2017 found that there was a lack of information about people’s mental capacity and communication in people’s care records. During this inspection in March 2018, we found that information about people’s communication and their capacity to make decisions was documented in care support plans.
The arrangements for the provision of meals were satisfactory. We saw that there was a weekly menu. We looked at the menu for the week of the inspection and noted that there was a variety of meals available. On the first day of the inspection we observed both people in the home prepared their breakfast with the support of a member of staff.
Each person in the home had an individual varied activities programme which was devised based on their interests. On the first day of the inspection we noted that one person went to a day centre and another person went to visit their family.
Our previous inspection found that there was a lack of evidence to confirm that regular audits were carried out in respect of various aspects of the care provided and we found a breach of regulation in respect of this. During this inspection, we found that the home had undertaken checks and audits of the quality of the service in areas such as health and safety, staff files, fire procedures, medicines management and care documentation.
During the first day of the inspection we found that there was a lack of management presence and we were not confident that there was a consistent and regular management structure in place in the home.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.