Archived: Walsingham Support - 56-58 Turnbull Close

Walsingham Support, 56-58 Turnbull Close is a care home located near Dartford, Kent. The service provides accommodation and personal care to a maximum of 12 people with learning and physical disabilities. At the time we visited there were 11 people living at the service. The people who lived at Walsingham Support, 56-58 Turnbull Close had diverse and complex needs such as learning disabilities, cerebral palsy, epilepsy, severe sight impairment and limited verbal communication abilities.

There was a new manager at the service. The new manager was undergoing registration with the Care Quality Commission. 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 and associated Regulations about how the service is run.

At our previous inspection on 02 August 2016, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Healthcare professional's guidance were not being followed. People's healthcare needs were not being adequately met. Staff had not appropriately adhered with eating and drinking guidelines. Premises and equipment had not been properly managed to keep people safe. The provider failed to operate an effective quality assurance system and failed to maintain accurate records and Staff had not received appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. We asked the provider to submit an action plan by 03 October 2016. The provider submitted an initial action plan on 05 September 2016 which showed how they planned to improve the service by November 2016. They then provided an update to this on 24 November 2016, 05 December 2016 and 28 April 2017, which showed some of the action plans had been met and some were still on-going.

At this inspection, we found that the provider had met all the breaches of the regulations.

Premises and equipment had been properly managed to keep people safe. We found a number of maintenance issues which were identified at our last inspection had been rectified. There was an on-going plan of maintenance in the home. The home smelt fresh and clean.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. All staff had received training in the Mental Capacity Act 2005 and all had an awareness of Deprivation of Liberty Safeguards.

There were sufficient staff on duty to support people with their needs. Staff attended regular training courses and refresher training was provided at regular intervals. This ensured staff had the skills to provide appropriate care. All staff received induction training at the start of their employment.

Staff had received regular individual one to one supervision meetings and appraisals as specified in the provider’s policy.

Robust recruitment practices in place. Applicants were assessed as suitable for their job roles.

Robust systems for the management of medicines were followed by staff and we found that people received their medicines safely. People had access to health and social care professionals when required.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided met their needs. New care plans had been introduced and were clear and detailed.

Our observations showed that people had a variety of activities. Activities were diverse enough to meet people’s needs and the home was responsive to people’s activity needs.

The provider and manager of Walsingham Support, 56-58 Turnbull Close had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the provider’s whistleblowing policy. They were confident that they could raise any matters of concern internally with the manager, or externally with the local authority safeguarding team.

Care files included communication passports, which provided clear descriptions of how people communicate.

People had access to nutritious food that met their needs. We observed that staff followed people’s nutrition and eating guidelines throughout the day.

Staff were clear about their roles and responsibilities. The staffing structure ensured that staff knew who they were accountable to. Staff meetings were held regularly. Staff old us they felt free to raise any concerns and make suggestions at any time to the manager and knew they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken. The manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained.

Walsingham Support - 56-58 Turnbull Close is a care home located near Dartford, Kent. The service provides accommodation and personal care to a maximum of 12 people with learning and physical disabilities. At the time we visited there were 11 people living at the service. The people who lived at Walsingham Support - 56-58 Turnbull Close had diverse and complex needs such as learning disabilities, cerebral palsy, epilepsy, severe sight impairment and limited verbal communication abilities.

There was no registered manager at the service during our visit. 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 time of our inspection, there were three acting deputy managers. Two were on shift during the inspection.

Premises and equipment had not been properly managed to keep people safe. We found a number of maintenance issues, which had been reported to the provider’s head office but repairs had not been carried out.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. However, not all staff had received training in the Mental Capacity Act 2005. Staff had limited awareness of Deprivation of Liberty Safeguards.

Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. However, staff training plan showed that staff did not have all the essential training they needed to ensure they understood how to provide effective care, and support for people. There was a gap in the training schedule which showed that staff were not fully equipped to meet people’s needs effectively.

Staff had not received regular individual one to one supervision meetings and appraisals as specified in the provider’s policy.

Effective systems were not in place to assess and monitor the quality of the service. There were no formal checks in place to ensure that all records were up to date. Care plans and assessments had not been consistently reviewed.

People had access to nutritious food that met their needs. We observed that people were provided with cold and hot drinks when they wanted them. However, we found that eating and drinking guidelines were not always followed by staff.

The systems for the management of medicines were followed by staff and we found that people received their medicines safely. People had good access to health and social care professionals when required. However, staff had not always followed healthcare professional’s guidelines.

The service had some risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs such as inability to verbally communicate, which could lead to behaviour that challenges and details of how the risks could be reduced. However, as much as having a good understanding of people’s difficult behaviours, staff had not always followed stipulated healthcare professionals guidance relating to people’s care needs. We have made a recommendation about this.

There were sufficient numbers of staff to meet people’s needs. However, the service had been using agency staff to cover 42% staff vacancies. We have made a recommendation about this.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs. However, care plans were disjointed with information either not recorded in care plan but recorded in another document. Care plans were not wholly person centred. We have made a recommendation about this.

Staff encouraged people to undertake activities. While some staff spent time engaging people in conversations, some did not. For example, we observed that when staff were putting make up on one person who was severely impaired, there was no interaction or engagement. This in house activity was task oriented and not person centred. Also, some people were observed watching television throughout our visit with little or no engagement from staff. We have made a recommendation about this.

People were protected against the risk of abuse. We observed that people felt safe in the service. Staff recognised the signs of abuse or neglect and what to look out for. Both the acting deputy managers and staff understood their role and responsibilities to report any concerns and were confident in doing so.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care.

People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

People spoke positively about the way the service was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the acting deputy managers were very approachable and understanding.

During this inspection, we found breaches of regulations relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. Many of the people who used the service had communication difficulties. This meant they were not always able to tell us their experiences.

The summary is based on our observations, discussions with people using the service and the staff supporting them, discussions with a relative and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

This is a summary of what we found -

Is the service safe?

We found that the service was safe for people who lived at the home. Staff were aware of their responsibilities concerning keeping people safe and clear guidance was available for staff. We found that people's needs, interests and wishes were clearly outlined in their care plans and records were updated to reflect any changing needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

We spoke to staff about how they met the needs of people living at the home. They were able to describe people's needs and interests and showed an awareness of how to support people appropriately. We observed people being supported in the home and saw that staff knew how to engage people with activities they enjoyed. Staff had received specialist training concerning how to meet the needs of people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We observed that staff had a positive approach when supporting people and they were polite and friendly. Staff we spoke with knew the interests and personalities of the people living at the home and we saw that they engaged with them and supported them to do activities they enjoyed.

Is the service responsive?

We saw that people's needs had been assessed and this information had been used to develop their care plans. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with friends and family.

Is the service well-led?

Staff we spoke with told us that the managers at the home were approachable and we saw evidence that they were meeting regularly with staff to provide them with the support they need to do their jobs. Staff told us they were clear about their roles and responsibilities. We saw that the provider regularly carried out audits to assess the quality of the service. People or their representatives were given opportunities to make their view known.

At our inspection of 27 December 2013 we found that staff did not have training in specialist areas that they needed to care for people living in the home such as training about how to support people with diabetes and epilepsy. When we visited on 20 May 2014 we found that this had been addressed and all of the staff at the home had received this training.

Most of the relatives we spoke with told us that they were happy with the service; one said 'On the whole the service is very good, I can rest easy knowing that I don't have to worry about my relatives safety and wellbeing.' Another said, 'The home is very clean and I think people are safe there'.

We found that the garden was well kept and free from hazards and that the premises were suitable for the purpose they were used for; being generally well maintained.

We found that the registered manger was supportive and responsive to the needs of the staff team, however staff were not always receiving specialist training that would enable them to deliver care and treatment safely and to an appropriate standard.

We found that people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on

There were 12 people living at 56-58 Turnbull Close. Some of the people in the home had complex needs which meant that they were not able to tell us their experiences of using the service; we therefore used our observations to help inform some of our judgements. We saw that people were being supported around the home by staff in a kind and sensitive manner, in a way that promoted individual independence. We also saw that some people used different methods of communication. For example, the use of signs or facial expressions. We observed that staff recognised these non verbal communication methods and responded appropriately.

We found that relatives and people who used the service had been kept involved in their care. Relatives of people told us that they were involved in decisions about their relatives care.

People we spoke with were able to communicate by using signs and told us that they "Liked" living at the home and "Liked" the staff.

Relatives of people we spoke with said that there was plenty to do both inside and outside the home. They told us that some people attended a nearby Activity centre where they took part in various activities such as swimming and exercise.

We found that appropriate checks were in place to confirm the suitability of staff to work with vulnerable people.