Background to this inspection
Updated
22 January 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
33 Station Road is 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 service did not have a manager registered with the Care Quality Commission at the time of the inspection, however recruitment had been completed and the new registered manager was due to commence their role the following week. During this period of no registered manager the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced. We gave the service 24 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at the home to speak with us.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider did not fully complete the required Provider Information Return. This is information providers are required to send us with key information about the service, what it does well and improvements they plan to make. There had been a comprehensive action plan implemented in the last three months to assist with addressing concerns which had been identified in the previous report and in the inhouse audit. We reviewed this information and took this into account in planning this inspection and making our judgement.
During the inspection-
We spoke with three people who used the service and one relative about their experience of the care provided. We spoke with three members of staff, two internal auditors who had been running the home in the absence of a registered manager and the area manager.
We reviewed a range of records. This included three people’s care records and three medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.
Updated
22 January 2020
About the service
33 Station Road is a care home on the outskirts of Chesterfield. The service offers personal and social care for up to six people with a learning disability and associated conditions. At the time of our inspection there were four people using the service.
The accommodation was over three floors and consisted of a lounge area, kitchen, separate dining room, bathroom with accessible equipment and two further shower rooms and toilets. The bedrooms were spread across the three floors. There was a lift available to support people to gain access to the upper floors. There was a large garden area to the rear of the property for people to use.
The provider has recognised the importance of the principles and values that underpin Registering the Right Support and other best practice guidelines and there has been acknowledgement from the provider that the current property was no longer suitable to meet the needs of the people living there, and alternative accommodation had been sourced. This guidance ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
At the time of our inspection four people were using the service. There were deliberately no identifying signs, intercom system, cameras, outside the property to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
Three months prior to our inspection we received information from the provider to highlight areas of risk within the service. The provider completed an action plan and had kept us informed of the changes they had made. We found that improvements had been made; however, some areas still required further actions and to provide us with the assurance of sustainability.
Improvements had been made to the documentation and systems to record and monitor people’s care. Previously, care plans had not been consistently updated and were not readily available for staff to provide people with their current care needs. Staff were now knowledgeable about people’s health conditions and support needs. These changes now need to be embedded and become part of the standard information.
Prior to the involvement of the internal quality audit team, the governance of the home had been insufficient to ensure that people received support to keep them safe and maintain their wellbeing.
Audits had not always been completed or used to develop improvements. Partnerships with health professionals had not always been developed to enhance the care available to support people and the staff. Where guidance had been provided, this had not always been followed. We saw recent improvements had been taken to address these issues and we now needed to be assured they could be sustained
Improvements had been made to staff training and support, there were plans in place to ensure all staff training was completed in a timely manner in the future.
People were safeguarded from the risk of abuse and avoidable harm and information was available for people on how to report any safeguarding concerns. Staffing levels were sufficient at the time of the inspection.
People received their prescribed medicines when they should, and staff had the required information to manage and administer medicines safely. The prevention and control of infection was managed safely. There was enough equipment to meet people’s needs. Health and safety checks on the environment had not always ensured people’s needs were effectively managed, however these have now been addressed. The provider anticipates the plans for alternative accommodation will address the remaining concerns.
Where people required support from staff with eating and drinking, this was provided by staff who were caring and unhurried. This supported people to have a positive mealtime experience.
People received care and treatment from staff who had a kind, caring and person-centred approach. Staff treated people with dignity and respect and their choices and decisions about how they received their care was upheld.
People’s communication needs were known and understood by staff. Advocacy information was available for people. People received opportunities to participate in social activities, these reflected people’s interests, hobbies and diverse needs.
People had access to the provider’s complaint policy and procedure; any complaints were acted upon quickly. People’s end of life care and wishes had been assessed and planned for. People were invited to share their views and wishes about the service they received, and staff felt involved in the development of the service.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Requires Improvement (published 6 December 2018) and there was a breach of Regulation 12. The provider had completed an action plan after the last inspection to show what they would do and by when to improve. Following a visit by the providers internal auditors in September 2019, it was identified several actions had not been completed and a team of experienced managers became involved, to further support the service to identify and act on concerns found.
At this inspection, we found improvements had been made and the provider was no longer in breach of the regulation. However, the service remains rated Requires Improvement until recent practices become fully embedded and sustained. This service has now been rated requires improvement for the last two consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 33 Station Road on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.