Archived: Foresight Residential Limited - 9 Park Road

We inspected on 31 July 2017 and the visit was unannounced, which meant the provider did not know we would be visiting.

At the last inspection in December 2014, the service was rated good. At this inspection we found the service remained good. There was a registered manager in post, who we have referred to as ‘the manager’ in this report.

Quality assurance checks in place were basic and did not include oversight from the provider. We have made a recommendation that the provider review their approach to quality assurance to include quality checks by them or their representative to ensure the consistent quality and safety of the service.

Staff we spoke with had a good understanding of the needs and vulnerabilities of the people they were supporting. They were able to describe different types of abuse and were confident to follow procedures should they need to raise a safeguarding concern. People who live at the service told us they felt safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had training and used distraction techniques to support people who found managing their emotions or behaviour difficult, as physical restraint was not used. No one was deprived of their liberty, but applications to lawfully deprive people of their liberty had been made for people who had been assessed as not being able to consent to their care.

Care plans reflected people’s specific needs and how people wished to be cared for. Some care plans we looked at needed to show more detail, to be updated and to show people’s current level of need.

Staff were supported through regular supervision and relevant training was available to assist them in their role. Some staff appraisals were overdue, but the manager was aware and had scheduled them to take place.

The administration of medicines were appropriately managed and staff received training and checks on their competence.

There were robust recruitment policies for permanent and agency staff. Agency staff were used to cover gaps in the rota. This demonstrated that the manager could make informed decisions when offering employment.

People were supported and encouraged to eat healthy foods and their individual food preferences and choices were respected. People we spoke with said they liked the food.

People were referred to health care professionals if staff had concerns, which ensured their health needs were being addressed.

Regular checks were completed to ensure the building and environment was safe, which included the fire alarm, gas and electricity. People could choose how they wished their bedrooms to be decorated and had personal items that were important to them.

People were involved with some of the day to day decision making about what they wanted to happen and easy read and pictorial documents were available to enable people to express their opinions.

People in the home had access to a range of activities and could follow their own interests. The manager and staff were committed to ensuring people had access to and were integrated into the wider community.

People's needs were assessed and their rights were respected by staff. We saw that people were encouraged to make their own decisions or were supported by the staff to consider options available to them. We observed staff treating people in a dignified way and with understanding and kindness. We observed a warm and friendly rapport between those living and working at the home and staff clearly understood the needs of those they were supporting.

People had care plans and risk assessments in place, which helped staff to understand and meet their needs.

We found people who used the service were safe and staff were aware of how to recognise and report any concerns about people's safety and wellbeing. We saw staff received regular training to ensure that they had the skills they needed to be able to look after people safely and competently.

We saw that there were sufficient staff on duty. Staff told us they received good support from the management team and that training was of a good standard. One member of staff told us, "We provide a good family atmosphere here, we all work well together.' Another member of staff told us, 'It is important to us that people here receive a good standard of care, we are all keen to do that.'

There were quality monitoring systems in place, which included relatives and staff, giving their written feedback about the care provided. We also saw that routine audits (checks) were being carried out. We saw questionnaires that had been completed by people who used the service, giving their views on the home. This gave a good overview of the quality of the service and provided feedback which if required, could be acted upon by the provider. This also meant that the quality of the service was being kept under review.

We had previously found that while some medication records were up to date and completed properly, the home did not have an adequate system for the recording of medicines, or for the auditing of their stocks. The numbers of some medicines in stock did

not tally with how many the home thought they should have. In addition, the home was not able to evidence whether the numbers of medicines in stock were correct, or whether some medication had been lost or misappropriated. This meant that errors, such as missed doses or overdoses, would have been less likely to be discovered.

We also found we found a recording error where the medication administration record (MAR) had been filled in to say the person had received their medicine that morning, but it was still in the box. We found old medicines in the cupboard which should have been disposed of.

On this visit we found that the home had improved procedures and introduced new practices for medication recording. They were able to demonstrate that numbers of medicines were being recorded correctly. This meant that people who use the service

were protected against the risks associated with the unsafe management of medicines.

We looked at the care plans for three people who lived at the home. Records for each person showed that the home had carried out sufficient assessment of the needs of each person, to enable appropriate care and support to be given.

Staff told us they enjoyed working at the home, and had been given sufficient training to enable them to feel confident in their roles. Comments included 'The training is really good and the manager is approachable' and 'I really enjoy my job and get satisfaction from seeing clients progress'. Training and staff records showed that staff had suitable qualifications and skills, and appropriate character checks had been carried out prior to a person being employed.

We looked at medication administration records and checked some people's medication to make sure that the records were correct. While some records were up to date and completed properly, we saw some recording errors had been made. We found that the home did not have an adequate system for auditing of their stock of medication.

This meant that the home was not able to evidence whether numbers of medicines in stock were correct. We have asked the manager to take action to improve the recording procedures and to carry out a full audit of the system.