Archived: The Ormerod Home Trust Limited - 2 Headroomgate Road

The Ormerod Home Trust Limited - 2 Headroomgate Road provides support to adults with a learning disability across the Fylde, Blackpool, and Wyre areas of Lancashire. People's support is based on their individual needs and can range from 24-hour care within a supported living environment to a set number of visits each week from the domiciliary service. The service provides personal care to people living alone or with family or friends in their own houses. It provides personal care and support to people so they can be as independent as possible. The supported living scheme enables people with a learning disability to live in supported accommodation. People have their own tenancies, with the properties being owned by different housing associations. The landlords are responsible for the maintenance and up keep of the individual properties.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. For example, we saw the location of people's homes enabled people to have easy access to health and social care services and the option to be a part of their local community.

People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living or domiciliary care; this inspection looked at people's personal care and support.

At the time of our inspection visit, The Ormerod Home Trust Limited - 2 Headroomgate Road supported 70 adults with a learning disability in supported housing and 45 adults who received domiciliary care.

There was a registered manager in place. A registered manager is a person who has registered with CQC 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. Having a registered manager is a condition of registration with CQC. The registered manager was not present during the inspection. An additional registered manager who was present for part of the inspection became registered with CQC during the inspection visits.

We carried out this comprehensive inspection because of a significant number of concerns and safeguarding matters about the care and management of the service. We assessed if there were ongoing regulatory risks to people who used the service. The service was working openly and transparently with the authorities whilst investigations were undertaken.

At our last inspection in December 2017 we rated the service good. At this inspection we found the service had changed to a rating of requires improvement.

Procedures were in place and staff told us they knew what to do if they saw poor practice or potential abuse. However, safeguarding/disciplinary practices did not always protect people from harm. Safeguarding alerts had been raised and investigated but the service had not always taken appropriate action. This increased risks to people supported.

This was a breach of Regulation 13.2 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure safeguarding processes were operated effectively to prevent the risk of abuse of service users.

Governance was not always effective. Although quality monitoring was carried out, the senior Management Team did not always receive sufficient or timely overviews of accident/incidents, complaints, audits or actions taken. This reduced their knowledge and the effectiveness of the service.

This was a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure systems or processes were operated effectively to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk.

A number of concerns had been raised with the senior management about communication and care. We were shown evidence of action taken, and in progress by the senior management to address concerns that had been brought to their attention. People were complimentary in the main about communication from staff. However, one relative told us communication was starting to improve although they did not always get consistent responses from the office.

Recruitment and selection checks had been carried out before new staff could start working for the service so the risk of unsuitable staff was minimised. However, we recommended that the service develop risk assessments to reflect staff medical conditions to improve safe working.

Although there had been a turnover of staff people told us they were usually supported by the same group of staff who they knew. They told us they were familiar with their needs and preferences. We had received comments regarding problems with staffing. We did not see this on inspection but recommended frequent reviews of staffing to ensure sufficient levels of skilled and experienced staff were employed.

Staff had received training in most areas about how to care for people which assisted them in carrying out their roles. However not all staff working with people whose behaviour could challenge, had completed positive behaviour training and one person did not have guidance for supporting them when they had behaviour that challenged.

Risk assessments were in place for almost all care records checked. This provided guidance for staff and assisted in supporting people safely. Staff supported people with and managed medicines in accordance with medicines guidance. People we spoke with told us staff supported them with medicines as prescribed. We saw all except one supported house carried out weekly monitoring audits of medicines. Staff in one house had not completed these for several weeks which meant errors or omissions in that house may have gone unnoticed.

People supported and their relatives told us staff supported them or their family member in a friendly and caring way. One person said, “All my staff are very polite and friendly.” A relative told us, “We have some fantastic carers. They are very diligent and know [family member] well.”

Staff supported people to get involved in shopping and preparation of a nutritious dietary and fluid intake and staff had completed food safety training. There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of infection.

Care plans were in place detailing how people wished to be supported. People who received support where possible or their relatives had been involved in making decisions about their care.

Staff understood the requirements of the Mental Capacity Act (2005). People who received support consented to care where they were able. Where people lacked capacity, appropriate best interests’ decisions were carried out.

People we spoke with knew how to raise a concern or to make a complaint. The complaints procedure was available to them and they told us any concerns were listened to and acted upon. People supported and their relatives said they were encouraged to give their opinions about the quality of care. They told us they were satisfied with the support they received.

The Ormerod Trust provides support to adults with a learning disability across the Fylde, Blackpool, and Wyre areas of Lancashire. People's support is based on their individual needs and can range from 24 hour care within a supported living environment to a set number of visits each week from the domiciliary service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. For example, we saw the location of people’s homes enabled people to have easy access to health and social care services and the option to be a part of their local community.

This service provides personal care and support to people living in 24 ‘supported living’ settings, so they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the time of our inspection visit there were 76 adults who received support from The Ormerod Trust. They also provide domiciliary care to 42 adults with a learning disability. It provides personal care to people living in their own houses and flat in their local community.

There was a registered manager in place. 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 the service was rated Good. At this inspection we found the service remained Good.

Although a number of people had limited verbal communication and were unable to converse with us, we were able to speak with 22 people who received support. They told us they were happy being supported by staff that cared for them and treated them well. One person said, “I am all right with the carers. I am quite happy. It’s a very nice house [Supported Living].” A visiting relative said, “This is [relative’s] house and she is the priority. I can’t believe how lucky we have been. This is the best house for her.”

Relatives told us they were made welcome by friendly and caring staff and had unrestricted access to their relatives when they visited them in their own supported living homes. They told us they were happy with the care provided and had no concerns about their relatives safety.

The registered provider told us they had ongoing recruitment to manage staff retention as several staff had left in recent months. However, people and staff told us they had had sufficient staffing levels to provide support people required. Within the supported living settings we met staff who knew people they supported very well. They were able to share people’s care needs and how best to support people. We observed there was an appropriate rapport between people and staff who supported them.

The service had systems to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported concerns to the commission when appropriate.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

Medication procedures observed protected people from unsafe management of their medicines. People received their medicines as prescribed and when needed and appropriate records had been completed.

We saw there was an emphasis on promoting dignity, respect and independence for people who received support. People told us staff treated them as individuals and delivered person centred care. People their relatives and care plans seen confirmed the service promoted people’s independence and involved them in decision making about their care.

The designs of the supported living homes were appropriate for the care and support provided. The registered provider had liaised with the local authority and housing associations to ensure people’s homes were appropriate and safe.

The service had safe infection control procedures and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff knew people they supported and provided a personalised service in a caring and professional manner. Care plans were organised and had identified care and support people required. We found they were informative about care people had received.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were available between meals to ensure people received adequate nutrition and hydration. Staff had information about people’s dietary needs and these were being met.

We saw people had access to healthcare professionals and their healthcare needs had been met. A visiting healthcare professional spoke highly about the care provided by the registered manager and her staff. They told us staff listened and worked closely with them ensuring people received good healthcare.

People and their relatives told us they enjoyed a variety of activities. These included attending day services, drama, baking and social evenings. We observed one person was excited about attending a forthcoming pantomime.

People told us staff were caring towards them. Relatives praised the positive caring attitude of staff. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

The service had information with regards to support from an external advocate should this be required by them. They worked with family members who were court appointed advocates to provide agreed standards of care.

The service had a complaints procedure which was made available to people and their relatives. People and their relatives we spoke with told us they were happy and had no complaints about the care delivered.

The registered provider used a variety of methods to assess and monitor the quality of the service. These included regular audits, questionnaires and relative meetings to seek their views about the service provided.

We last inspected this location in July 2014, and the service was found to be compliant with the regulations it was inspected against. Shortly after this inspection in July 2014, the chief executive (appointed December 2013), undertook a review of the systems and procedures operated by the service. Polices were updated to reflect current best practice and new legislation such as the Care Act, easy read documents were produced for tenants to use and a new quality assurance was introduced.

The registered manager was on duty when we visited the service. 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.

Prior to our inspection visit, we were notified of an allegation of financial abuse. The local safeguarding team and police were involved in the investigation of the allegation. The allegation centred on missing finances. This matter had been dealt with by the Trust, and lessons learnt from the incident had led to changes and improvements to the finance recording systems operated by the service.

The Trust provides services to a small number of people who do display challenging behaviours; the number of safeguarding alerts is higher than expected. In discussion with the chief executive, we were reassured that this higher than expected figure was not necessarily as a result of staff being unable to deal with situations, or because risks had not been properly assessed. The underlying reasons can be attributed to the unpredictable nature of some of the behaviours displayed by individuals and the clash of personalities between tenants. The Trust had good systems in place to ensure that incidents were properly reported. On occasions, incidents or situations that were not later defined as a safeguarding issue, were reported: this showed that the Trust had an open and transparent culture.

Staff knew what to do and who to contact if they thought anyone was at risk of harm. Risks to individuals had been identified and plans were in place to make sure risks were kept to a minimum. Where people needed their medicines to be administered by staff, there were clear procedures in place to make sure administration was carried out safely. Door wedges were seen to be used in tenant’s homes to keep doors open, some being designated fire doors, and we made a recommendation that the Trust seek advice and guidance from the local fire service regarding their usage.

There were enough staff, of suitable skill and character to make sure people’s needs were met. Before new staff started work, the provider carried out proper checks to make sure they were fit to work at the service. Staff were able to attend training that provided them with skills and knowledge to carry out their roles effectively.

Staff had a good understanding of the requirements of the Mental Capacity Act 2005 (MCA). Appropriate action had been taken to make sure legal requirements were followed where restriction on a person’s movement was a concern.

People received the support they needed with their personal care. Where people had particular health needs there was clear information about the support people required. Staff were aware of individual preferences and how best to assist people in the way they wanted. They demonstrated a caring and warmth in the way they discussed the people they supported. People had regular reviews of their care and support to make sure any changes in needs were identified and acted on.

The registered manager had been in post since September 2014. They had a good overview of the service and had identified areas that needed to be improved. In particular there had been a number of changes in management over the last few years and this had positively affected staff morale. The registered manager was keen to provide a consistent and open management style.

Is the service caring, responsive, safe, effective and well led? Below is a summary of what we found. The summary is based on our observations during the inspection.

We spoke at length to nine relatives; visited four properties operated by the Trust and spoke to people using the service; spoke to staff and managers from the Trust; reviewed a range of records held by the Trust, and reviewed the information we held that related to the operation of the Trust.

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

Is the service safe?

People were treated with respect and dignity by the staff. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. The Trust had responded appropriately to the potential for abuse occurring and that local guidance had been put into practice. The records showed that reasonable steps to identify and report abuse had been taken, and that further discussions would be taking place in order to ensure risks are minimised. Systems were in place to ensure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. Equipment was maintained and serviced regularly therefore not putting people at unnecessary risk. Recruitment practice was safe. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected. Out of Nine relatives we spoke with, eight said that that they believed their loved ones lived in a very safe and caring environment. However, one relative raised concerns that due to the unpredictability of other service users behaviour, they thought their relative was at risk of harm. Safeguards were in place to deal with these behaviours.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support. People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing their care plans and they reflected their current needs. Relatives told us that their loved ones lives had been enhanced due to way the Trust supported them.

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. People using the service said that they felt their needs were very well met by the staff. One relative said that the staff were very helpful, and knew their relative very well. They added that the staff were quick to respond to requests for help. We observed the staff work with people in positive ways, giving them time to think, treating them with care and respect, and responding to their requests for help and support. We found that people's nutritional needs were met. One person said that they knew they could always turn to a staff member for help and reassurance.

Is the service responsive?

People completed various activities in and outside the service. People knew how to make a complaint if they were unhappy. Several relatives told us that the Trust worked proactively to meet people's needs and responded to their requests to live a life that was active, independent and full of choice.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had a quality assurance system; records showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the Trust and wanted to ensure it was implemented.

The service demonstrated good practice that ensured people were cared for in a supportive and respectful manner. One person told us, 'I get a lot of support from the Ormerod, I couldn't manage without them'. A relative said, 'I feel confident in the management and the support offered'. This was underpinned by the service's in-depth understanding of consent and related processes.

Care practice and record-keeping was underpinned by clear, regular auditing procedures. Practices in relation to staff recruitment and induction appeared to be safe and adequate.

We observed that staff were able to provide treatment in a respectful, timely and unhurried way. This was because staff were supported to carry out their duties effectively.