Archived: HF Trust - Old Quarries

HF Trust Old Quarries is a residential care home. It provides individualised support for people with a learning disability. The service is made up of a number of houses and bungalows on the same site where individuals are supported to live as independently as they are able. The service is registered to accommodate up to 33 people, there were 21 people living there at the time of our inspection.

Old Quarries is due to close although there is no official closing date. Some people were anxious about the transition and the service understood these anxieties and were doing what they could to support people. There had been a re-structure of staff recently at the service and some staff had been made redundant or were moving to other job roles. This was having an impact on people, relatives and staff who clearly felt frustrated by the changes.

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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was safe. There were sufficient staffing levels to ensure safe care and treatment. Risk assessments were implemented and reflected the current level of risk to people.

People were receiving effective care and support. Staff received training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).

The service was caring. We observed staff supporting people in a caring and patient way. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence.

The service was responsive. Support plans were person centred and provided sufficient detail to provide safe, high quality care to people. There was a robust complaints procedure in place and where complaints had been made, there was evidence they had been dealt with appropriately.

The service was well-led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. Regular meetings for staff and people who used the service were being completed.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At our comprehensive inspection of this service on 2 and 8 June 2016 we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with one warning notice and four requirement notices stating they must take action. We shared our concerns with the local authority safeguarding and commissioning teams.

This unannounced inspection was carried out to assess whether the provider had taken action to meet the warning notice.

However, the service remains in ‘Special Measures’ until we carry out a comprehensive review. This will allow us to see if the improvements made have been sustained over time and check if action has been taken in relation to the requirements made at the last inspection. We will then be able to assess and rate each of our five key questions.

The purpose of special measures is to:

-Ensure that providers found to be providing inadequate care significantly improve.

-Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Old Quarries on our website at www.cqc.org.uk.

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 found that the provider had taken action to address the serious issues highlighted in the warning notice.

A new system had been implemented for recording medicine errors. Any medicine error is now recorded on an incident form and this is sent to specific people so that they can be reviewed to ensure appropriate action had been taken. A weekly audit of medicines held in stock is now being carried out. Staff are checking Medicine Administration Records (MAR) and stock checks of tablets every four hours.

Accident and incidents were now being fully recorded and monitored for any actions that could prevent reoccurrence. There had been three accidents since our last inspection. The records detailed how the accident had occurred, the action taken at the time and any learning that could be taken to prevent a reoccurrence.

Maintenance issues had been addressed and the building was in a better state of repair. Missing tiles and plaster had been replaced. The bathrooms were clean and there was no mould. Systems were now in place to monitor and take appropriate action promptly in relation to on-going maintenance. This was completed by the registered manager and the regional manager during their monthly visits.

There had been a change of management structure and the regional manager said that this would need some time to embed. Supervisions were taking place and a matrix was being used to record when these happened and would happen in the future. All staff would have an individual learning plan by the end of December 2016 and appraisals had been booked to commence from January 2017. We were assured by the regional manager that these would be in place when we returned for our comprehensive inspection.

Daily notes had improved and contained more information; however these were still brief and did not give sufficient detail about what people had been offered to do and what they had actually done. We were told these were being monitored by the registered manager as part of a monthly compliance tool.

The improvements reported above must now be sustained. Further actions the provider has told us they will take to address the requirements contained in the report of our visit on 2 and 8 June 2016 must also be fully implemented.

Old Quarries is due to close although there is no official closing date. People were uncertain and anxious of a transition to new homes. Staff and people had been consulted but we saw no evidence that needs assessments or transition plans had been updated. This provided an uncertain future for some people living at Old Quarries and this was having a significant impact on those people. After the inspection the provider gave us details of emails and updates people and staff had received between August 2015 and June 2016. There had been two newsletters for staff on redevelopment and staffing arrangements. People had been encouraged to attend meetings with information about the transition plans within the same timeframe. We were told that Old Quarries would update transition plans for everyone by 19 August 2016.

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 responsibilities for meeting the requirements in Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was not safe. The provider did not have effective systems to assess, review and manage risks to ensure the safety of people. Risk assessment processes were inadequate. Guidance was not available for staff on how to support people safely. Digital and paper records contained different information. Risk assessments were not always completed thoroughly. People’s medicines were not always being managed safely.

We found the service was not always effective. Staff were not receiving regular supervision or support. No appraisals had been carried out for any staff within the last 12 months. Staff received on-going training and support to attend external training if they wished to.

The premises were in need of redecoration and were not always clean. A cupboard had fallen off the wall in one person’s kitchen leaving a bare wall and a large chunk of plaster was missing from another area. Both of these had been recorded in the maintenance book over four weeks ago but nothing had been done.

The service was not responsive to people's needs. Support plans and risk assessments were out of date and lacked the detail required to provide consistent, high quality care and support.

The service was not well led. The registered manager and provider had governance systems in place to monitor the quality of the service provided. However, these systems had not identified the concerns we found around medicines management and assessing risks. Staff team meetings were not being held regularly, there was no agenda and the minutes lacked detail. The minutes were of a poor quality with no review or completion of actions.

Sufficient numbers of staff were available to keep people safe and meet their needs. The use of agency staff had, however, reduced staff consistency and this in turn had negatively impacted on people's care. Some people were not being supported to reach their full potential. There was no record of review or progress for some people for many years. Staff told us they aimed to help people live as independently as they were able to.

People using the service were positive about the care they received. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they like to do and how they like to be supported.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at that back of the full version of this report.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special

measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Below is a summary of what we found. The summary is based on our observations during the inspection, from speaking with people who use the service and with the staff supporting them and from looking at records. We spoke with seven people who lived in the home although not all the people commented on the service provided. One person told us that they liked the house where they lived. They showed us their room and said that they liked the colour it was painted and they had arranged it how they liked it. The person told us that they liked to go out to the shop and the pub with staff support.

If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people were treated with respect and dignity by the staff. There were medication procedures and medication was stored safely in each house. Staff received training so that they could administer medicines to people in a safe way.

Each person had a series of risk assessments which included the action that was needed to reduce risk and keep people safe. There were also general risk assessments and risk management plans so that the people who lived in the home, staff and visitors were kept safe. There was a disaster plan to make sure that people were kept safe if there was an emergency.

There were systems to make sure that managers and staff learned from events such as accidents and incidents, medication errors, complaints, concerns, and investigations. This reduced the risks to people and helped the service to improve continually.

The home had policies and procedures about the Mental Capacity Act and Deprivation of Liberty Safeguards and staff had been trained to understand when an application should be made, and about how to submit one. Staff were in the process of reassessing people's capacity to make decisions and considering any restrictions and possible deprivations of liberty. They were also making Deprivation of Liberty Safeguards applications to the local authority as necessary. This meant that people would be safeguarded as required.

We saw that there were enough staff so that they were not rushed and could respond to people calmly. This helped to make sure that people's needs were always met. Before staff were employed they had thorough recruitment checks to make sure they were suitable to work with people. Staff received a range of training and could work towards qualifications so that they had the right skills to support people and keep them safe.

The manager audited the quality of service once a month to make sure that the service was safe.

Is the service effective?

People's health and care needs were assessed and each person had a detailed support plan so that staff knew how to support them. Information about people's previous lives, their likes and dislikes and what was important to them was recorded in their plans. The support care plans were regularly reviewed and updated so that they reflected people's current needs.

Each person had their own room and these were furnished and decorated as they wished.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person told us that staff supported them to shop for things that interested them and to go out to the pub for lunch.

People could give their views about the service through a people's representative and where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in line with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. Staff took care to find out what each person was interested in so that they could provide activities that suited their needs.

People and their relatives knew how to make a complaint if they were unhappy. There had been only one recent complaint. We looked at how this had been dealt with, and found that the response had been open, thorough, and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

There was a regular group meeting to obtain people's views and action was taken in response to comments.

The service was being changed and people had been asked for their views about where they wanted to live and who with. Plans for the new service were being based upon their views.

Is the service well-led?

The organisation had a computer system which contained information about the service such as the mission statement and values, staff training, policies and procedures and records. Staff had access to this information so that they could be clear about what was expected of them.

The service worked well with other agencies such as the social care commissioners, community nurse, psychologist and GP to make sure people received their care in a joined up way. The service has notified CQC of incidents as required.

The service had a quality assurance system. We saw records, which showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff we spoke with were clear about their roles and responsibilities. The service manager told us that the senior managers in the organisation provided good support and direction.

We visited three houses and spent time in communal areas with people supported by the service so that we could observe the direct care, attention and support that they received. We observed there was constant interaction between staff and people in the home. We noted people were relaxed, happy and comfortable in each other's company.

People had a choice at mealtimes. Staff told us some people were able to prepare themselves breakfast and lunch with supervision but some people were unable to and meals were prepared by the staff on duty.

People we spoke with told us they were involved in completing cleaning schedules throughout the week. Tasks included vacuum cleaning, mopping floors, cleaning bedrooms and communal areas. Staff told us cleaning was planned with people individually on set days of the week that suited people.

Staff told us they supported people to maintain their own bedrooms and encouraged people to decide on the layout of their bedrooms. Staff told us this was because people would find any change difficult and people needed staff to support them through changes that may impact on their personal space.

We asked people if they knew about their care plan. Most people said they did and were involved in what was written in it. Staff demonstrated they had a good understanding of how to support people with learning disabilities. They told us they knew about people's families and background, their likes and dislikes and indicators of when people needed emotional support or were not well.

When we spoke with staff about safeguarding vulnerable adults they demonstrated a good understanding of the nature of abuse and their responsibilities in respect of reporting abuse. The home had a safeguarding policy and information available to staff on reporting procedures. In staff files we saw evidence that staff had attended training in the safeguarding of vulnerable adults and whistleblowing. Staff received appropriate professional development. We spoke with three care workers who told us they thought they were well supported by the management team.

We saw the provider's policy and procedure for responding to and dealing with complaints or concerns raised. No concerns were raised to us during our visit to the home.