To Be Confirmed
During a routine inspection
The inspection was carried out on 23 and 24 September 2015 and was unannounced. At the previous inspection in December 2013, we found that there were no breaches of legal requirements.
L’Arche Kent Faith House provides accommodation and personal care for up to five adults with a learning disability and there were four people living there at the time of the inspection. The philosophy of L’Arche is that people with disabilities live in a community. Therefore, some staff members also live in the home. The accommodation is over two floors, with some bedrooms on the ground floor and some upstairs. There is a communal lounge and a large dining room/activities room and a garden to the rear of the home. .
The home was run by a registered manager. 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. However, the locality leader and not the registered manager were in day to day charge of the home. The locality leader was present at the home on a daily basis, organised staff rotas and training and was available to people who used the service and their relatives. The locality leader was responsible for managing the service and also part of the companies supported living scheme.
Staffing levels did not always reflect people’s assessed needs as staff were not available when some people got up in the morning. There had been, and due to the recruitment of staff for short periods of time, there would continue to be a high turnover of staff at the home so that people were not supported by a consistent staff team.
Assessments of risks to people’s safety and welfare were carried out and identified people’s specific needs, and how these risks could be minimised. However, when people’s needs had changed and they needed less support, a formal assessment process to any potential risks had not always been carried out.
Health and safety checks were not effective in ensuring that the environment was safe and that equipment was in good working order. An internal audit had identified that the home had not kept up to date with fire drills and maintaining firefighting equipment. Also, a record was not kept to show when people visited the home, so that staff knew who was in the home in the event of a fire. Comprehensive checks were not carried out on all staff at the home, to ensure that they were fit and suitable for their role. Applicants were interviewed and criminal record/barring checks were undertaken. However, the reason for gaps in people’s employment history were not routinely sought. An employment reference had not been gained from one person whose last work was with vulnerable adults.
The management of medicines was potentially unsafe. Staff competency in administering medicines safely had not been checked to ensure that people received their medicines as intended by their doctor. There were no guidelines in place for staff to follow for people who had been prescribed medicines which should be given ‘as required’.
The laundry room was unhygienic as the flooring had a temporary repair which allowed water to penetrate. The units in the room were damaged making them difficult to clean. Not all staff were not following the home’s procedure when dealing with soiled laundry.
Staffing levels had been assessed to make sure that there were enough staff on duty during the day and night to meet people’s individual needs.
Clear and comprehensive guidance was in place for staff about how to recognise and respond to abuse and staff knew how to put it into practice.
The house was clean, but there were shortfalls in the maintenance and refurbishment of the home. This resulted in rooms, such as the laundry room and bathrooms in need to attention. Although systems for reporting maintenance concerns were in place, it was difficult to track when issues had first been raised and when and if they had been completed. Some entries had first been made over a year ago, showing that issues of maintenance were not dealt with in a timely manner.
People’s health needs were assessed and professional advice was sought when it was needed. However, important information about people’s health care needs had not always been transferred to all records about their care. Where people were required to drink a specific amount of fluid each day to maintain their health, the amount they drank each day had not been totalled to monitor that they were drinking sufficient amounts.
Staff understood people’s likes and dislikes and dietary requirements such as if they had allergies or needed their food cut into small pieces so that they could swallow it more easily. However, the menu showed that the meals people ate were very similar each week and we have made a recommendation about this. Meal times were relaxed and a positive social experience for people.
New staff received a comprehensive induction, which included shadowing more senior staff. Staff were trained in areas necessary to their roles and staff had completed some additional specialist training to make sure that they had the right knowledge and skills to meet people’s needs effectively.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Staff showed that they understood their responsibilities under the Mental Capacity Act 2005. DoLS applications had been made for people who lived in the home to ensure that people were not deprived of their liberty unnecessarily. However, the provider had not notified the Commission when Deprivation of Liberty Safeguards had been granted by the local authority, which they are required by legislation to do so.
Some staff lived at Faith House with people who used the service, and all staff knew people well. Good positive relationships had developed with staff who treated people with kindness and compassion. Relatives described the service as “unique” because of the way that people were treated as equals with staff.
The home was not open and transparent when dealing with concerns and complaints. A formal complaint had been made about the home and action taken to respond to it, but the home had not recorded or identified this as a complaint about the service. When a person had raised a number of verbal concerns about the home, the home’s complaints policy had not been followed, which stated that verbal complaints or concerns should be treated as formal complaints.
People’s care, treatment and support needs were personalised and identified in their plans of care, but not all parts of their plans had been reviewed to ensure that they were an accurate record. People knew that they had a plan of care and had been involved in its development.
People led active, busy lives and were fully involved in community life with L’Arche and the wider community. People had the opportunity to take part in a wide range of differing activities and maintain their faith. People regularly went on holiday in Europe and to take part in Christian festivals.
There were not robust systems in place to review the quality of the service. The home was not proactive and waited until they were aware that things had gone wrong, before trying to put them right and improve the service. Neither was the home proactive in gaining the views of relatives and stakeholders of the service. This meant that there was not a culture of continuous improvement in the home.
The home was managed on a day to day basis by a person who was not registered with the Commission to do so. The registered manager was office based, acted as a senior manager and only visited the home every two weeks. We have made a recommendation in relation to the day to day management of the service.
Most relatives said that they would recommend the service as it was unique and integrated people into life in the L’Arche and wider community. Staff were aware of the aims and values of the service to treat people who used the service as equals.
We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.