Archived: Nottingham Neurodisability Service - Aspley

When we last inspected the service in November 2016, we found multiple breaches of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as requires improvement and we asked the provider to make improvements to meet the legal regulations. During this inspection we found that some of the required improvements had been made, but further improvements were still required, this resulted in us finding some on-going breaches of the Health and Social Care Act 2008 Regulations (2014). We also found further concerns which led to a further breach of the regulation. You can see what action we told the provider to take at the back of the full version of the report.

The service did not have a registered manager in place at the time of our visit. The registered manager had recently left the service and the present service manager told us they were going to apply to become the registered manager in the near future.

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 risks to people’s safety were not always assessed robustly and information in the risk assessment was inconsistent. Staff did not always follow the information in people’s risk assessments to ensure safe care.

People were at risk of exposure of abuse and neglect as the measures in place to protect them were not always robust and recommendations were not always followed by staff.

The management of medicines was not always safe as staff did not follow guidance in place around safe practices. When monitoring safe storage of medicines staff had not raised with the management team when they found areas of concern. There was a lack of auditing of medicines and some protocols for people who required medicines on an ‘as and when required’ basis, did not give staff the information required to safely administer these medicines

The principles of the Mental Capacity Act 2005 were not always followed. People were not supported to make decisions for themselves and it was not clear that decisions made on their behalf had been done so in their best interests.

Staff were supported with adequate training for their roles and a sufficient number of staff were employed to care for people.

Majority of people were supported with their nutritional needs but there were occasions when the lack of staff knowledge in relation to people’s diets, put them at risk of receiving foods that were not appropriate for them.

People’s health needs were not always well managed as staff did not always follow instructions from health professionals to assist them to manage these.

People were not always treated with respect and at times the cultural needs of people were not always met. People’s privacy was maintained but they were not always supported to maintain their dignity.

People did not always receive individualised care as the information in their care plans was not consistent and staff caring for them did not always have the knowledge of their needs.

The service offered a range of social activities for people but some people told us the activities on offer did not always meet their needs.

People felt able to raise complaints and concerns to staff and the service manager and felt they would be responded to. The service displayed a complaints policy in a format that people could understand.

The provider had continued to fail to report significant events that occurred to enable us to monitor the service.

There were a lack of robust auditing systems in place to monitor the quality of the service and this significantly contributed to the on-going breaches of regulations found at the service.

There was a lack of structured support and supervision for staff who worked at the service

People and staff told us the management team were approachable and people who lived at the service had some opportunity to give their views on how the service was run.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that provider’s found to have been providing inadequate care should have made significant improvements within this timeframe.

The service did not have a registered manager in place at the time of our inspection. The registered manager left the service in August 2016. 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.

People were not always protected from risks associated with their care and support. Staff were not always deployed in a way which ensured people received care and support when they needed it and medicines were not always managed safely. People were supported by staff who knew how to recognise abuse and how to respond to concerns.

People were supported by staff who did not always have the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions but people who lacked the capacity to make certain decisions were not always protected under the Mental Capacity Act 2005.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff knew their likes and preferences. Staff cared about the individuals they were supporting.

People’s support needs were not planned for appropriately. There were inconsistent activities to provide people with a stimulating life based on individual needs and preferences. People knew how to raise concerns and felt these would be listened to.

The systems in place to monitor the quality of the service were not always effective and this had led to deterioration and breaches of regulation being found. People were involved in giving their views on how the service was run and the management team were approachable and supportive.

People had a choice of suitable and nutritious food and were supported to maintain their nutrition and hydration. One person said, 'The food is lovely and there is always a choice.' Another said, 'There is always something on the menu I like.'

People told us they felt safe in the home and we saw there were systems in place to protect people from harm or the risk of harm.

Medication was administered to people safely and in line with instructions from their doctor or other health professional. People told us staff gave them their medication when they were supposed to.

People were supported by staff who were trained and supported to deliver safe care and treatment. People spoken with gave positive feedback about the staff working in the home. One person told us, 'I like the staff, they get me to be as independent as possible but help me where I need it'.

People were receiving care as detailed in their care plan. For example, one person needed a special diet and we observed lunch and saw this was provided as detailed in their care plan. People we spoke with told us they were happy with the care and support they received from staff.

Medicines were prescribed and given to people appropriately. We spoke with three people using the service about their prescribed medicines. They told us that staff gave them their medicine and they were given at the times prescribed by their doctor.

There was a relaxed atmosphere in the home and we saw that people using the service were comfortable talking to staff. We saw staff were kind, patient and genuinely cared for the people they were supporting. Staff had been recruited effectively to ensure they were safe to work with vulnerable adults.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. People we spoke with told us they would feel comfortable raising issues with the manager or staff and felt confident that any complaint would be dealt with by the manager.