Archived: A G Palmer House

Updated 5 February 2016

We carried out this focussed inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider had taken the appropriate action to raise standards within the service following being served two warning notices at out inspection in June 2015.

This inspection took place on the 18 December 2015 and was announced. The inspection team consisted of two inspectors. The lead inspector who attended the site visit was supported by another inspector who did not attend the site visit but made class to people and their relatives to obtain their views.

Prior to our inspection we reviewed the information we held about the service. This included the action plan that had been developed to support the required improvement and additional information to evidence the changes being made and plans for future improvement.

At the time of the inspection there were 76 people being supported by the service. We spoke with eight people who was using the service and four peoples relatives. We spoke with the manager and two members of the quality team. We also spoke with eight staff. We reviewed seven people's care files and records relating to the general management of the service.

Updated 5 February 2016

We inspected AG Palmer House on 22 June 2015. The inspection consisted of four visits in total between the 22 June and 3 July 2015. AG Palmer House provides personal care to people living in their own homes in Oxfordshire. The service also provides personal care to people who are receiving a service from the provider’s supported housing projects. The majority of people who receive a service have mental health needs.

At our last inspection in September 2013 we required the service to make improvement with regard to the care and welfare of people who used the service. We found that there was no information about how risks were managed or what steps were being taken to reduce the risk to the people using the service. The provider sent us an action plan in December 2013 stating the action they would take to improve the service to the desired standard. At this inspection in June 2015, we found that these improvements had not been made.

There was a registered manager in post at the time of our 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 2008 and associated regulations about how the service is run.

People had risk assessments in place that documented risks in relation to their needs. However, these risk assessments still did not always document strategies staff should take to mitigate these risks. On one occasion staff had been unable to provide care because they were un-prepared to manage risks.

We reviewed care files of people who lived in their own homes as well as people who were supported within a project setting. We observed there to be a noticeable difference in quality between the two. People living in their own homes had clearer more organised care plans in place. However the areas of improvement we found applied to all people using the service.

There were enough suitably qualified and skilled staff to ensure care was provided to people, however staff were not always deployed in a way that met people’s needs or supported their well-being.

Staff we spoke with had a good understanding of safeguarding, what constituted abuse and what action they would take if they suspected abuse. However the service was not always following the procedure set by the local safeguarding authority.

The service had an awareness of the Mental Capacity Act (MCA) 2005. The MCA is the legal frame for ensuring people right to make their own informed choices is respected. However we found the organisations systems were not supporting this understanding through their records. We have recommended that the service familiarise themselves with the MCA code of practice to improve this area.

The service had a system in place to support staff through formal supervision meetings and appraisals. However this system was not being used effectively and many staff were not receiving this support as a result. Staff told us they felt they were supported but would benefit from more formal meetings to discuss progress and plan their development.

People’s planned care was not always person centred. People’s records did not reflect their involvement or the involvement of other relevant people. Care was not clearly designed around the person’s wishes and preferences.

The service had systems in place to monitor the quality and safety of the service but they were not effective. Intended audits were not recoded to evidence improvement of the service. Spot checks that were designed to monitor the direct quality and safety of service delivery were also not being carried out consistently. There was also no local system to monitor accidents and incidents that occurred within the service to support the organisation in learning from these events.

Some staff were described as caring. Relatives provided lots of positive feedback with regard to more experienced or regular staff who were described as, “excellent” and “like angels”, but these views were not shared by everyone in relation to staff generally. We were told of some staff who were rushed or brusque in their approach which impacted on peoples well-being.

We were told of a recent review of the service that had identified some of the concerns we had found and action was being taken to try and improve the areas of concern however, this action had not been taken at the time of our inspection and not all of the issues we had identified had been identified in this review.

We inspected AG Palmer House on 22 June 2015. The inspection consisted of four visits in total between the 22 June and 3 July 2015. AG Palmer House provides personal care to people living in their own homes in Oxfordshire. The service also provides personal care to people who are receiving a service from the provider’s supported housing projects. The majority of people who receive a service have mental health needs.

At our last inspection in September 2013 we required the service to make improvement with regard to the care and welfare of people who used the service. We found that there was no information about how risks were managed or what steps were being taken to reduce the risk to the people using the service. The provider sent us an action plan in December 2013 stating the action they would take to improve the service to the desired standard. At this inspection in June 2015, we found that these improvements had not been made.

There was a registered manager in post at the time of our 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 2008 and associated regulations about how the service is run.

People had risk assessments in place that documented risks in relation to their needs. However, these risk assessments still did not always document strategies staff should take to mitigate these risks. On one occasion staff had been unable to provide care because they were un-prepared to manage risks.

We reviewed care files of people who lived in their own homes as well as people who were supported within a project setting. We observed there to be a noticeable difference in quality between the two. People living in their own homes had clearer more organised care plans in place. However the areas of improvement we found applied to all people using the service.

There were enough suitably qualified and skilled staff to ensure care was provided to people, however staff were not always deployed in a way that met people’s needs or supported their well-being.

Staff we spoke with had a good understanding of safeguarding, what constituted abuse and what action they would take if they suspected abuse. However the service was not always following the procedure set by the local safeguarding authority.

The service had an awareness of the Mental Capacity Act (MCA) 2005. The MCA is the legal frame for ensuring people right to make their own informed choices is respected. However we found the organisations systems were not supporting this understanding through their records. We have recommended that the service familiarise themselves with the MCA code of practice to improve this area.

The service had a system in place to support staff through formal supervision meetings and appraisals. However this system was not being used effectively and many staff were not receiving this support as a result. Staff told us they felt they were supported but would benefit from more formal meetings to discuss progress and plan their development.

People’s planned care was not always person centred. People’s records did not reflect their involvement or the involvement of other relevant people. Care was not clearly designed around the person’s wishes and preferences.

The service had systems in place to monitor the quality and safety of the service but they were not effective. Intended audits were not recoded to evidence improvement of the service. Spot checks that were designed to monitor the direct quality and safety of service delivery were also not being carried out consistently. There was also no local system to monitor accidents and incidents that occurred within the service to support the organisation in learning from these events.

Some staff were described as caring. Relatives provided lots of positive feedback with regard to more experienced or regular staff who were described as, “excellent” and “like angels”, but these views were not shared by everyone in relation to staff generally. We were told of some staff who were rushed or brusque in their approach which impacted on peoples well-being.

We were told of a recent review of the service that had identified some of the concerns we had found and action was being taken to try and improve the areas of concern however, this action had not been taken at the time of our inspection and not all of the issues we had identified had been identified in this review.

We identified six breaches of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we have required the provider to take at the end of this report.