Wagtail Close

In addition, the service provides care and support to people living in four specialist ‘extra care’ housing schemes located across Bradford. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. Of the four Extra Care Housing Schemes, three were predominantly for elderly people and the fourth provided care and support to predominantly younger disabled adults.

The service also provided support to a number of people living in more individual properties close to one of the Extra Care Housing Schemes.

Not everyone using the Extra Care Housing Schemes receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of the inspection the service was providing care and support to 113 people.

People’s experience of using this service:

People told us they were happy with the care and support they received. They said that regular staff knew them well and were good at their roles. Some people did say that the effectiveness of care and support was sometimes compromised by the use of agency staff who did not know their needs as well, but that this was not usually a regular occurrence, although the prevalence of this varied dependant on which scheme people lived at.

People were kept safe from abuse. Risks to people’s health and safety were assessed and clear plans put in place for staff to follow. People received their medicines on time and when they needed them.

Staff received a range of training and support to undertake their roles. We found staff to be knowledgeable about the people and topics we asked them about.

People’s care needs were assessed and the service worked with a range of professionals to meet individual needs. People were supported to eat and drink enough.

Staff treated people with kindness and compassion. We saw examples of people’s independence being promoted by staff. People reported good outcomes whilst using the service.

Since the last inspection a number of improvements had been made. There was good management oversight of the service and the management team undertook a range of checks to ensure the service performed to an acceptable standard.

People’s feedback was sought on a regular basis. This included at resident meetings, care reviews and although regular questionnaires. The management team were receptive to people’s comments and complaints and acted on them.

Rating at last inspection: The last inspection report was published in April 2018 with a rating of Requires Improvement.

Why we inspected: This was a routine inspection to check whether the service had made improvements since the last inspection.

Follow up: ongoing monitoring;

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe management of medicines and good governance to at least good. We found medicines administration sheet (MARs) were well completed and people were receiving the correct medicines. However, robust quality systems should have identified and actioned some of the concerns we found at inspection such as accuracy of care records, financial management of some people's monies, listening to people's views about the running of the service, taking actions as a result to improve the service.

This service provides a domiciliary care agency and a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The domiciliary care agency provides personal care to people living in their own houses and flats in the community, some of which are based in 'extra care' facilities. It provides a service to older adults and younger disabled adults. Wagtail Close provides a respite care unit and accommodates three people in one adapted building. The domiciliary care service was providing personal care for 122 people at the time of our inspection;some people receiving personal care from the domiciliary care live in the extra care services of Dove Court, Mary Seacole Court and Eden Gardens. Some people receive night care support but this is provided currently by another agency.

A registered manager was 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. The registered manager was supported by locality managers based at each of the 'extra care' facilities.

Most people or their relatives told us they felt safe with the service provided. We saw staff had been trained to recognise signs of abuse and appropriate referrals had been made to the local authority. However, we found more robust systems were required to protect people from the risk of financial abuse. Following our inspection the registered manager put extra safeguarding measures in place to mitigate this risk. However, this should have been identified and actioned prior to our inspection.

Medicines were mostly managed safely and the service was no longer in breach of Regulations regarding the safe management of medicines.

Accidents and incidents were recorded and the registered manager was taking steps to ensure outcomes of these were fully documented, including lessons learned. Risks to people's safety were assessed and care plans put in place to mitigate these risks.

Sufficient staff were deployed to keep people safe. Some concerns were expressed by staff cover during night time and agency staff, with concerns raised about some staff not being fully aware of people's care and support needs. The registered manager was aware of this and told us this was being reviewed. Staff were recruited safely and were subject to annual appraisal and regular supervision. We saw the separate areas of the service had their own training matrixes and most staff training was up to date or booked. We have made a recommendation about the service maintaining accurate and clear systems to ensure staff training is kept up to date.

Most people and/or relatives told us the service met their health care needs and took action if they were concerned about people's health. Our review of people's care records confirmed this.

The service was meeting the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberties Safeguards. We saw evidence of consent being sought during our inspection although more evidence of people's consent to care and support needed to be present in care records.

People were satisfied with the food on offer at Wagtail Court and said a good selection of meals were available to choose from. People who received support with their meals within the domiciliary care service told us they were satisfied with the food prepared by staff.

People and their relatives told us some staff were caring and treated them with compassion and kindness whereas they felt other staff had a less compassionate and caring approach. Staff respected people's privacy and dignity.

Although people had individualised care records in place, these did not always reflect up to date and accurate information. For example, clearer and more accurate guidance was required for staff who supported people with their nutritional intake. Care records needed to show more evidence of people being involved in the planning and review of their care and support. This lack of evidence reflected what some people and/or their relatives told us about not having taken part in care planning or reviews.

Although there had been no formal complaints we saw a complaints policy was in place and displayed at Wagtail Close. People told us they knew how to make a complaint if necessary.

Activities were offered at Wagtail Close according to people's preferences and they were made welcome at social events at the provider's extra care service next door.

People and staff spoke positively about the management team and said they could approach them with any concerns. We found the registered manager open and keen to make improvements within the service.

Some people and/or their relatives told us their views about the service quality had not been sought and some people told us they did not feel listened to. Some people told us when their views had been sought they had not been told of any actions taken as a result.

Although a system of audit and quality assurance was in place, this had failed to recognise some of the concerns we found at inspection. This meant the provider was not meeting the requirements of the law and was in breach of Regulations.

You can see what action we told the provider to take at the back of the full version of the report.

Our last inspection took place on 22 January 2016 and at that time we found the service was not meeting five of the regulations we looked at. These related to safe care and treatment, person centred care, receiving and acting on complaints and good governance. This inspection was therefore carried out to see what improvements had been made since the last inspection.

At the time of inspection there was no registered manager in post although the manager was in the process of registering with the Commission [CQC]. 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.

We found there were a sufficient number of staff employed for operational purposes and the recruitment procedure was designed to ensure only people suitable to work in the caring profession were employed. We found staff received training to protect people from harm and they were knowledgeable about reporting any suspected abuse.

The staff we spoke with were able to describe how individual people preferred their care and support delivered and staff working within the domiciliary care service understood the importance of treating people with respect in their own homes. Staff told us the training provided by the service was good and they received the training and support required to carry out their roles effectively.

The manager demonstrated a good understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and staff demonstrated good knowledge of the people they supported and their capacity to make decisions.

We saw care plans and risk assessments were in place which identified specific risks to people’s health and general well-being. However, we found they had not always been reviewed and updated as required and this had not always been identified through the internal audit system. We also found that although medication policies and procedures were in place staff did not always follow the correct procedures which meant we could not be confident people received their medicines as prescribed.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received and this was available everyone who used the service.

There was a quality assurance monitoring system that was designed to continually monitor and identify shortfalls in service provision. However, we found the shortfalls in the service highlighted in the body of this report had not always been identified through the quality assurance process.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report. .

Wagtail Close provides both a respite care facility and domiciliary care service to people living with physical disabilities, sensory loss. brain injury or learning disability.

At the time of our inspection the service was providing respite care to one person and domiciliary care to 24 people.

The registered manager for this service left their position in December 2015. A new manager is in post and has applied to CQC for registration. A registered manager is a person who has registered with the Care Quality Commission (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.

People who used the service and staff told us they had confidence in the new manager to give them support.

People who used the service told us they felt safe. Staff were familiar with the systems in place to protect people from risk of harm.

Accidents and incidents were recorded but the systems for the overview of accidents to identify any trends or themes were not being followed.

People who used the service told us staff were very good. However we found staff training was not up to date.

People told us staff were available as they needed them. People using the domiciliary care service did not report any late or missed calls.

People were supported to receive a diet that met with their nutritional and cultural needs. However not all people were supported to receive a diet that met their personal preferences.

People were supported to access healthcare services as the need arose.

People told us staff were respectful of their privacy and dignity needs. However we found the actions of some staff restricted people in their right to choice.

Care was planned with a person centred approach and people told us they were aware of the detail in their care plans and were involved in their development and review.

Complaints about the service were not being managed well and the complaints procedure lacked sufficient detail to enable people to make a complaint.

Governance systems were not being followed to make sure complaints about the service or accidents and incidents were being audited effectively.

We found five breaches of regulations and you can see what action we told the provider to take at the back of the full version of the report.

During our inspection we spoke with six service users and looked at four care files. People told us and we could see from records that people were asked before any treatment was give. We were also told that people were treated with respect and dignity and were involved in their plans of care.

We could see there was a relevant safeguarding procedure in place that staff followed and concerns were being reported in the correct way.

Staff told us they received interviews and references and identification checks were carried out. All staff we spoke with had a CRB (Criminal Records Bureau) check within the past two years.

We could see the service had a relevant Statement of purpose which indicated to anyone visiting the service exactly what happened and who was registered for what activities.

People also told us they liked the staff and got on well with them. "The staff are very good. I never have to wait long for help' and "Staff always try and work round what we want".

Within the caf' and centre we saw that people were comfortable with staff and had a good rapport with them. It was clear that staff knew the people they were supporting well.

People we spoke with said that there were plenty of activities going on, they felt that there were enough choices and opportunities to enjoy and participate in planned events. Staff also supported them to enjoy individual activities, such as shopping, cinema trips or meals out.

People also told us they had one to one planning meetings with staff about what they would like to do and how they would like to be supported.

People confirmed that the home was well managed and the manager worked alongside them to make sure the service was running well and in the best interests of people who use the service. They all said the manager and senior managers were supportive and approachable.