Archived: The Island Residential Home

The inspection was carried out on 13 August 2015. Our inspection was unannounced. This was a focussed inspection to follow up on actions we had asked the provider to take to improve the service people received.

The Island Residential Home is a privately owned care home that provides accommodation and personal care for up to 44 people. There were 32 people living at the home on the day of our inspection. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Accommodation is arranged over two floors. There is a passenger lift for access between floors.

The registered manager had stepped down from directly managing the service in 2015. A new manager had been employed. The new manager was in the process of applying to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At our previous inspection on 10 February 2015 we found breaches of seven regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. We took enforcement action and required the provider to make improvements. We issued four warning notices in relation to the safety and suitability of the premises, management of medicines, recruitment records and quality assurance and told the provider to comply with the regulations by 31 March 2015. We found three further breaches of regulations. We asked the provider to take action in relation to person centred care, staffing levels and nutrition and hydration.

The provider sent us an action plan on 30 May 2015 which stated that they would comply with the regulations by the end of June 2015 for six regulations and by September 2015 for Regulation 17 (Good Governance).

At this inspection we found that improvements had been made. The provider had met the requirements of the warning notices we issued at out last inspection. However we found some breaches of regulations relating to the fundamental standards of care.

The provider had failed to carry out checks to explore gaps in one member of staffs employment history. The provider had carried out necessary employment checks to ensure staff were suitable to work with people.

Medicines were stored, administered and disposed of safely. People received the medicines they needed when they needed them. However, there was no signature list to identify which members of staff had been trained to administer medicines. We made a recommendation about this.

Audits and systems to monitor the homes were still being developed. Some audits had taken place. The audit of staffing records had failed to identify that the employment history was not complete for one staff member; we found that 35 years of employment history was missing. We made a recommendation about this.

The provider failed to display their inspection rating following their CQC inspection in February 2015 and the publication of their report in May 2015.

Staff knew and understood how to protect people from abuse and harm and keep them as safe as possible. The home had a safeguarding policy in place which listed staff’s roles and responsibilities to keep people safe from abuse.

People were protected from harm because their safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified, such as falls, mobility and skin integrity.

The home had undergone a number of repairs and alterations. For example, new windows had been fitted, the gardens had been cleared, uneven paving had been corrected to prevent accidents, and a new fire escape had been fitted. A program of improvements had been developed which meant that improvements would be continuing over the coming year.

People told us that they did not have to wait for their care needs to be met. For example, call bells were answered promptly. There were enough staff on duty to meet people’s needs. Staffing numbers had increased to meet people’s assessed and changing needs.

Staff had undertaken training relevant to their roles. They said that they received good levels of hands on support from the management team to enable them to provide the care people needed.

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. Staff had a good understanding of the MCA 2005and Deprivation of Liberty Safeguards (DoLS) so that they understood how to protect people’s human and legal rights.

People had choices of food at each meal time. People were offered more food if they wanted it and people who did not want to eat what had been cooked were offered alternatives. People with specialist diets had been catered for.

People received medical assistance from healthcare professionals when they needed it.

People told us they found the staff caring, and that they liked living at The Island Residential home.

Staff were careful to protect people’s privacy and dignity and people told us they were treated with dignity and respect, for example staff made sure that doors were closed when personal care was given.

People and their relatives and visitors had access to communal areas, gardens and people were able to spend private time together. People’s information was treated confidentially. Personal records were stored securely to protect people’s privacy.

People told us that the home was responsive and when they asked for something this was provided.

Care plans included information on; personal care needs medicines, leisure activities, nutritional needs, as well as people's preferences in regards to their care. This meant staff had the guidance they needed to provide appropriate care and support for people.

People told us activities had improved. People were engaged with activities when they wanted to be. The manager and activities staff were developing a new activities schedule.

People knew who to talk to if they had a complaint. The complaints policy was displayed on the wall of the home. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales for a response.

Completed satisfaction surveys showed that there were high satisfaction levels amongst people and their relatives, particularly in the area of quality of care and staff attitudes. Relatives told us that they were kept well informed by the home and they were able to attend regular meetings and were able to speak with the manager and provider when they needed to.

People told us they were happy with the changes the provider had made to the home.

Staff were well supported by the management team. The provider and management team were visible throughout the home. Staff told us that they felt confident to contact the management team and were confident that they would gain support.

The new manager was aware of their responsibilities. They had developed links with external organisations to improve information sharing and good practice so that people received a good service.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection was carried out on the 10 February 2015 and it was unannounced.

The Island Residential Home is a privately owned care home that provides accommodation and personal care for up to 44 people. There were 31 people living at the home on the day of our inspection. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Accommodation is arranged over two floors. There is a passenger lift for access between floors.

The Island Residential Home has 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 and associated Regulations about how the service is run.

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 came into force on 1 April 2015. They replaced the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People felt safe in the home and their needs were met. All the relatives we spoke with felt that their family members were safe. However, our own observations and the records we looked at did not always match the positive descriptions people and relatives had given us.

The safeguarding policy was not up to date and did not give staff adequate guidance. However, staff knew to report safeguarding concerns to their manager and the local authority.

There were risk assessments in place for people. The assessment identified the risk or potential harm to the person or to staff, the actions to be taken and by whom. The risk assessments did not have a specified date for review and had not been updated when people’s needs changed.

The home had not been suitably maintained and effective systems were not in place to identify hazards and ensure action was taken to protect people from harm. Although maintenance contracts were in place; suitable action had not been taken to address risk when there were faults.

The provider and registered manager did not have a tool or system to assess the level of staffing in relation to people’s needs. There were sufficient numbers of staff working at the home, but they had to complete household tasks which had a negative impact on the time they were able to spend with the people at the home.

Effective recruitment procedures were not in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

Medicines were not always stored, administered and recorded safely. Medical advice had not always been followed. Medicines that were classed as controlled drugs (CD’s) under the Misuse of Drugs Act 1971 had not always been recorded appropriately.

Medicines competency checks were carried out when staff had completed medicines training. However, there were no records of these checks. We made a recommendation about this.

People’s nutrition and hydration needs were not always met.

Staff told us that if a person had been recommended to have a pureed diet, then all the components of the meal would be pureed together. This meant the person would not know what they were eating the person’s choice was restricted.

Care was not consistently planned to meet people’s assessed needs. Assessment and care plans lacked information to support staff to provide safe, consistently or in a person centred manner. Personal histories had not been included in people’s care plans to support this approach.

There were limited planned activities within the home which would provide stimulation and interest.

The complaints procedure did not evidence the provider’s responsibility to investigate complaints and did not detail who people should talk to if they were not happy with the complaint response. We made a recommendation about this.

People had completed surveys in September 2014. Concerns raised within the surveys had not always been responded to in a timely manner.

There was no evidence to support an audit framework at the home. Health and safety audits that had been undertaken by the provider were not robust. Policies and procedures were out of date and not fit for purpose.

Staff had received training relevant to their roles and were well supported by the registered manager. Staff communicated effectively with people and demonstrated that they would only support people when they had gained their consent and according to their wishes and choices.

The staff were knowledgeable about the principles of the Mental Capacity Act (MCA) 2005. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the MCA Code of Practice. The managers understood when an application should be made and they were aware of a Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

We observed people eating their meals in the dining rooms. Some people chose to eat with other people and others chose to eat alone. Staff served the food and helped people if they needed support.

Staff were kind, caring and patient in their approach and had a good rapport with people. They gave people plenty of time to communicate their needs. Staff demonstrated respect for people’s dignity. They were discreet in their conversations with one another and with people who were in communal areas of the home. People’s information was treated confidentially.

People were supported to maintain their independence. We saw that people were encouraged to do things for themselves.

People and their relatives were confident to raise problems with the registered manager if they needed to. Relatives had completed surveys and the results were positive.

The home had a calm and relaxed atmosphere. The calls bells were answered quickly. Staff demonstrated that they understood and promoted the home’s values.

You can see what action we told the provider to take at the back of the full version of the report.