Archived: Care Management Group - 1 Charmandean

The home had a 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 undertaken on the 8 and 9 June 2015 we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to inadequate processes for assessing and monitoring the quality and safety of services provided. The provider sent us an action plan stating they would have addressed all of these concerns by 30 September 2015. At this inspection we found that the registered manager had made improvements and this breach of regulation had been addressed.

Staff understanding of their responsibilities with regard to the Mental Capacity Act 2005 was not consistent and embedded within practice. Some staff did not have a clear understanding of Deprivation of Liberty Safeguards (DoLS) and some mental capacity assessments and best interest decisions were not always completed in line with legal requirements. This was identified as an area of practice that needed to improve.

People told us they felt safe living at the home and relatives said they felt their relations were safe. One relative said, “I have seen very good, safe practice.” People were receiving their medicines safely and risks to people had been assessed and plans were in place to manage risks. There were enough staff to care for people safely and the provider had a robust recruitment system to ensure that suitable staff were employed. Staff were able to explain how they would recognise signs of abuse and knew what action to take.

Staff told us that they felt well supported and received the training and support they needed to carry out their roles effectively. Training provided was relevant to the needs of people living at the home.

People told us they enjoyed the food at the home and a relative told us, “The food is very much home cooking and it looks really good.” Risks associated with eating and drinking had been assessed and were managed effectively. Advice received from specialist, such as speech and language therapists (SALT), had been incorporated into people’s care plans and staff were following these instructions carefully. Some people were living with complex health conditions and staff were proactive in supporting them to access the health care services that they needed.

People and their relatives spoke highly of the staff and the caring relationships that had developed. Staff knew people well and supported them to be involved in planning their care and support. One person told us, “All the staff are nice, they help me.” A relative said, “The care is amazing.” People were treated with dignity and their privacy was respected.

People were leading full and busy lives. Staff supported people to follow their interests with a range of activities and people accessed the local community regularly. People were supported to maintain relationships that were important to them.

Care plans were personalised and enabled staff to provide care in a person centred way. Staff were observant and noticed small changes in people’s needs. One relative said, “Staff have to watch for changes daily, sometimes hourly. They are very responsive.” Any concerns or complaints were dealt with promptly and people and their relatives told us that they would feel comfortable to raise any issues with staff.

The registered manager was approachable and provided clear leadership. Staff were clear about their roles and knew what was expected of them. One staff member told us, “It’s a good place to work, and morale is very good.” People and their relatives also spoke highly of the management of the home. One relative told us, “From what I have seen I would rate the manager very highly.”

There were effective systems in place to monitor the quality of care and the registered manager had oversight of the running of the home. Incidents and accidents were monitored and analysed to ensure that care plans were adapted and updated to prevent further occurrences. Staff described an open culture where they felt able to raise any concerns and where their views and ideas were welcomed. Relatives described a good relationship with staff and the manager. One relative said,

“The management of the home is more consistent and thorough now and the staff take personal pride in the care they provide.”

During this inspection we looked at evidence to help us answer our five key questions; Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well lead?

This is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We found that the service was not always safe. We asked the registered manager if there had been any incidents in the previous eighteen months as we had not been notified of anything since March 2013. They told us there had been incidents during the time they had worked at the service but said they had not been good at reporting these to the Commission. Incidents between service users that were abuse or potential abuse had not always been identified by the registered manager and staff, and had not always been discussed with, or reported to the local safeguarding authority.

We saw that people's risk assessments had been completed and were reviewed regularly which ensured staff had up to date guidance in how to manage risks to people.

Staff had been recruited through a robust recruitment procedure which checked their suitability for working with vulnerable adults. For example, checks were made on their employment background, previous employment and character references and identity. Each staff member had completed a satisfactory criminal records check before starting work.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke to the registered manager about DoLS and were told there were two people who lived at the home who had capacity. Applications for DoLs were in progress for the other six people who did not have mental capacity which meant they would not be at risk of having their liberty unlawfully restricted.

Is the service caring?

We found the service to be caring. We observed staff interaction with people was kind, respectful and helpful. One person we spoke with told us 'The staff help me a lot' and when asked if staff looked after them well, another person told us 'Of course they do.'

Is the service responsive?

We found that the service was responsive. We saw that staff were available and responded to people's day to day care and support needs, such as eating and taking part in activities. People received input from healthcare professionals, such as their GP, chiropodist or dentist when they required specialist advice or treatment.

Is the service effective?

We found that the service was not always effective. Most people received the care they needed and this was delivered in line with their support plans and staff supported people to achieve their goals. We saw that one person had received support from a psychologist to help them manage their behaviour. However, staff told us the behaviour support plan was not working very well which led to on-going behaviour that challenged. They told us they had raised this with their manager and requested a referral to psychiatry. At the time of the inspection we were told that no additional specialist advice had been received to help the person with their behaviour. However. the provider wrote to us following the inspection and told us they had held a review and had put additional support in place.

Is the service well led?

We found the service was not always well led. There were some systems in place to monitor the quality of the service, such as the quarterly audit; however, actions identified were not always followed through.

The registered manager had not guided staff about what abuse or potential abuse might look like in relation to incidents between people living at the home and how to act appropriately if they saw this type of abuse or potential abuse.

There was not an effective system in place to monitor, review or learn from incidents.

Staff received regular supervision and training and told us they felt well supported by the manager.

Checks were carried out on the environment and equipment, such as water temperatures, bath hoist and wheelchair safety checks.

We read in care records that every person had a personalised care and support plan that was suitable to their needs and reviewed regularly. We saw from reading people's daily diaries and from observation that care plans were being followed by staff. We saw that there were regular community meetings where people's views were listened to and valued. We saw that regular audits of the service were completed by staff ensuring that people who used the service benefited from a service that constantly monitored its quality of care provided.

We spoke to and observed staff caring for people and they displayed a thorough knowledge of the people that they cared for including personal preferences.

Staff told us that that had adequate training in order to provide good quality care and were well supported in order to meet the needs of the people in the home. We inspected staff training records and saw that all staff had received safeguarding training and that their responsibility was well understood.

We read in care records that every person had a personalised and individualised care and support plan that was suitable to their needs and read reviews that were held with people, their representatives and external professionals. We saw, from reading people's daily notes and from observation, that care plans were being carried out by staff.

We spoke to staff about residents and they displayed a thorough knowledge of the people that they cared for. This was confirmed by our observations and by what we were told by a carer.

We saw notices around the home informing people and visitors how to complain or raise a safeguarding concern. We saw procedures and read that staff and people often discussed safeguarding matters.

We inspected staff records and we saw that staff received suitable training to undertake their roles. We observed there were enough staff to provide care and activities for people when we visited.

We read a number of audits and surveys and saw that feedback was sought from people and that the service had good quality systems in place.