Archived: Azalea House 2

The home is registered to provide care and support for up to three people with mental health needs and learning disabilities. The home is located next door to its sister home, Azalea House 1. Both homes share facilities which include the garden and communal areas. People living in both homes also move freely from each location and staff also support each other. The homes are currently registered as two separate locations although they work as one. For the purpose of this report we will be focusing on Azalea House 2.

We carried out a responsive focused inspection on 7 December 2016. When we completed our previous inspection we found concerns relating to the areas of safe, effective and well-led. At our last inspection we rated the service requires improvement. At this inspection we found the provider had made improvements in these areas.

The home had 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.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure that people were protected from the risk of acquired infections. People’s medicines were managed safely, and there was evidence of learning from incidents.

People’s needs had been assessed regularly and they had care plans in place that took account of their individual needs, preferences, and choices. Staff had regular supervisions and they had been trained to meet people’s individual needs effectively.

The requirements of the Mental Capacity Act 2005 were being met. 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.

People were supported by caring, friendly and respectful staff. Staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing.

Staff regularly reviewed the care provided and were guided through regular input by the person receiving care to ensure the care provided continued to meet their individual needs, in a person centred way.

The provider had an effective system to handle complaints and concerns.

The service was well managed and the provider’s quality monitoring processes had been used effectively to drive continuous improvements. The registered manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service. Collaborative working with people, their relatives and other professionals resulted in positive care outcomes for people using the service.

Further information is in the detailed findings below.

The inspection was carried out in response to information of concern which had been received.

At this inspection we looked at these specific areas to check if the provider was meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Azaelia House 2 provides care and support for up to three people with mental health needs some of whom may have a learning disability.

The registered manager at the service had recently resigned. Therefore, the service did not have a registered manager. The provider had put arrangements in place for two interim managers to support the service. 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.

During this inspection we found that fire checks had not been consistently maintained; however the fire panel was regularly serviced by an approved operative. Electrical equipment at the service had been appropriately checked and deemed fit for use. A certificate for the hard wiring of the premises had been issued to confirm it complied with current safety regulations. The staff rota reflected that the staffing numbers were sufficient to meet the needs of people using the service.

The practice in place to ensure that newly appointed staff had been supported with an induction was not consistent. Mandatory training for staff was kept under review and arrangements had been made for staff to access other essential training to support them in their roles and responsibility.

People were not consulted when there was a change to the menu; however, their nutritional and hydration needs were being met and they were enabled to prepare snacks and drinks of their choice daily.

The service did not have a registered manager in post. As a result there was a lack of consistency in how the service was managed and led.

Azalea House 2 is registered to provide care and support for up to three people who are living with a mental health or learning disability illness. There were three people living at the service when we visited.

The service 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 2008 and associated Regulations about how the service is run.

Staff had been trained to recognise signs of potential abuse and how to report them. People reported feeling safe in the company of staff.

There were processes in place to manage identifiable risks. People had risk assessments in place to enable them to maintain their independence.

The provider carried out recruitment checks on new staff to make sure they were suitable to work at the service.

There were suitable and sufficient staff available to support people with their needs.

There was a system in place to ensure people were supported to take their medicines safely and at the appropriate times.

Staff had been provided with induction and ongoing essential training to keep their skills up to date. They were also provided with regular supervision and appraisal.

Staff ensured that people’s consent was gained before providing them with support.

People were supported to make decisions about their care and support needs; and this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People were supported to maintain a balanced diet and were able to make choices on what they wished to eat and drink.

If required, people were supported by staff to access healthcare facilities and were registered with a GP.

Positive and caring relationships had been developed between people and staff.

There were processes in place to ensure that people’s views were acted on; and staff provided care and support to people in a meaningful way.

Where possible people were encouraged to maintain their independence and make decisions. Staff ensured their privacy and dignity were promoted.

Pre-admission assessments were carried out before people moved into the service. This was to ensure that their identified needs would be met.

A complaints procedure had been developed to enable people to raise concerns if they needed to.

There was an open and inclusive culture at the service; and the leadership was transparent and visible, which inspired staff to provide a quality service.

Effective quality assurance systems were in place to monitor the quality of the service provided and to drive continuous improvements.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Regular checks of the environment were made to identify any cleaning or maintenance requirements. We saw that staff carried out checks to make sure the premises were safe. However, some parts of the premises were poorly maintained and in poor decorative order. Some window panes in the laundry area were missing and had been boarded up. Broken furniture had been left outside waiting for removal for at least several weeks.

People who used the service told us that they felt safe and that they had no concerns about how staff treated them. They told us that they had people they could speak with if they had any concerns. Staff received training to ensure they understood their responsibilities in relation to safeguarding the vulnerable adults in their care. Staff also knew who to contact to report any suspicions of abuse.

Is the service effective?

People who used the service told us that they received the care and support that they needed. We saw that people's needs had been assessed and care plans developed according to their needs, wishes and aspirations.

It was clear from what we saw and from speaking with people who used the service, that staff understood people's care and support needs and knew them well.

Is the service caring?

Conversations were calm and relaxed and staff treated people with dignity and respect. People told us that all staff always treated them with respect.

Through discussion with staff, people who used the service and looking at records, we found that staff took account of people's individual needs.

Is the service responsive?

People's care needs were reviewed regularly which helped to ensure that people continued to receive care that was appropriate and effective. We found that staff were aware of indicators that may trigger deterioration in mental or physical health. Records showed that staff responded to changes in mental or physical health, reviewing risks and providing additional support where necessary.

Is the service well-led?

We found the service was well managed. The registered manager and staff were experienced and had a good understanding of the ethos of the home. Staff received training appropriate to meeting the needs of people who used the service.

We saw that people who used the service and staff were provided with opportunities to give their views on the service. Quality assurance processes were in place to assess and monitor the quality of care and support. We saw that where issues were identified most of these had been acted on. However we found that arrangements for maintenance and the upkeep of the premises did not ensure issues were addressed in a timely manner.

People said that they were happy with the care provided. We observed that staff treated people with respect and dignity. Interactions between staff and people were positive. People were encouraged to make personal choices in relation to the care and support they received and were enabled to express their views.

We found that people were asked for their consent to be supported and the provider acted in accordance with their wishes.

The home had procedures in place to ensure that people were protected against the risk of acquiring a health care associated infection.

We found that the home had effective recruitment procedures to ensure that appropriate checks were undertaken before staff commenced work.

The home was adequately staffed to meet people's needs. A person who used the service said, 'The staff are very good. They have helped me to change my life. I would be in' if I did not have them. I can't thank them enough for helping me.'

We found that records relating to the care and treatment of people and other records were appropriately maintained and stored securely.