Archived: Sanctuary Home Care Ltd - Barnet

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

There are 63 flats at the service. At the time of our inspection, 24 people were receiving support with personal care.

People’s experience of using this service:

People and their relatives told us people felt safe living at the service. Most people living at the service told us staff were caring and kind, but several people told us there were some staff who rushed them, or were a bit abrupt. The registered manager planned to hold face to face meetings with each person to gather their views on this issue. Feedback from health and social care professionals and family members was very positive.

There were robust infection control procedures at the service and the registered manager had worked with the people living at the service and their relatives to minimise the spread of COVID-19..

There were enough staff to meet people’s needs and care records set out people’s needs and preferences. Risk assessments were in place to provide guidance for staff in providing safe care.

Medicines were safely managed. Medicines were stored in people’s homes and documentation was regularly audited by the management team.

The registered manager and team leaders were very well regarded by staff, people using the service and relatives. We saw staff were suitably trained to care for people at the service. Quality audits took place to ensure the care offered was of a good standard.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last inspection report was published on 14 June 2017 and the service was rated Good.

Why we inspected:

The inspection took place as part of a schedule of planned inspections. We carried out a focused inspection of this service on 20 April 2021. This report only covers our findings in relation to the key questions safe, effective, caring and well led as we were mindful of the impact and added pressures of COVID-19 pandemic on the service.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sanctuary Home Care Ltd –Barnet is a registered domiciliary care service that provides personal care to people who have a variety of needs. The service is registered at Goodwin Court an extra care service consisting of 63 flats. At the time of our inspection there were two vacant flats and three people were in hospital.

There was a registered manager in post who was familiar with 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.

At our last inspection on the 30 March and 7 April 2016 we found three breaches of the regulations. At our inspection in 2016 we found breaches in staffing as staffing levels had not been reviewed to meet people’s increased needs. As such people were not always receiving the hours of support they were assessed to receive. At our visit in 2017 we found that people had been reassessed and some people had moved to more appropriate care settings where for example, their nursing support needs could be met. People were now receiving the support hours they were assessed to receive. However people told us staff were “always rushed” in particular at weekends. We found there had been some staff shortage due to staff sickness and difficulty in finding staff to work at short notice at the weekend. The registered manager had taken steps to address this by recruiting staff specifically to work at the weekend.

At the last inspection we found that some people with complex support needs had not been risk assessed to minimise the risk to themselves and others in a timely manner. In our inspection in March 2017 we found that risk assessments were thorough, detailed and updated to reflect changes in people’s circumstances.

In our inspection in 2016 we found that medicines were not always stored in a safe manner. At this inspection we found that there had been a change in the medicine administration and storage procedure. Medicines were now stored appropriately in people’s own flats and medicine administration guidance was clear and updated on a regular basis.

In our inspection in 2016 we found staff had not received appropriate training to support them in their role. During our visit in 2017 we found that staff had received training to support them and that they were receiving regular supervision sessions with their team leaders.

People told us they felt safe and staff demonstrated they knew how to report safeguarding adults concerns appropriately. The registered manager demonstrated they learned from safeguarding adult concerns and implemented new guidance for staff for instance when there had been medicine errors.

The registered manager was aware of their responsibility to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Care records reviewed demonstrated that people were asked their consent, and mental capacity assessments and best interest meetings took place appropriately.

People were supported to access the appropriate medical services in a timely manner and were supported to eat a nutritious diet and to remain hydrated.

People described staff as caring and the service promoted people’s diversity support needs through written guidance and people’s care plans. Care staff were able to tell us how they respected people’s dignity and privacy. People had detailed person centred care plans that identified their support needs and how they wished to be supported. Staff supported people to attend communal activities within the service.

People told us they felt safe to complain and we saw that complaints had been recorded, investigated and apologies were written when appropriate.

The service had good lines of communication between management and staff. In addition to a number of ways people could feedback with regard to their experience of care given. The service quality assured the service given by the use of audits and recruitment checks.

At the last inspection that took place in July 2014 the service met the standards inspected.

Sanctuary Home Care Ltd is registered domiciliary care service that provides personal care to people who may have dementia, mental health, eating disorders, learning disabilities and/or autistic spectrum disorder and people who misuse drugs and alcohol. At the time of inspection there were 66 people living at Goodwin Court receiving a service from Sanctuary Home Care Ltd.

There was a registered manager in post. 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.

Goodwin Court is a purpose built block that provides extra care housing. Sanctuary Care Ltd undertook the housing management of the building separately to their care and support service. People live in their own flats. The building is fully accessible and has lifts to each floor. There are some communal areas such as a lounge and dining room, an activities room, a conservatory and quiet garden room with an accessible garden.

Most people told us they liked living at Goodwin Court describing staff as caring. We observed most staff to be respectful of people and friendly in their interactions with people.

We found that some people’s support needs had increased but the provider had not reassessed people’s needs in a timely manner and staffing levels had not been reviewed to meet the increased need. People were not always receiving the hours of support they were assessed to receive. There had been a high staff turnover in recent months with a high use of agency staff. The recently appointed registered manager had stopped the use of agency staff by time of inspection and recruited more permanent and bank staff to the service. However the team was still in the process of settling into their new role.

We found that some risk assessment had taken place and there were regular reviews however some people with complex support needs had not been risk assessed to minimise the risk to themselves and others in a timely manner.

Most people said they received their medicines on time, we found medicine storage was not appropriate but the service was in the process of changing the medicine storage arrangements and were working with people and their families to make the process safe.

Staff understood their responsibilities to report safeguarding adult concerns and concerns had been reported by the service to the appropriate authorities.

The service was clean and well maintained with regular environmental checks and repairs taking place.

People living at the service had capacity with regard to their care and treatment. The staff had received Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) training and asked people’s consent before they supported them.

Staff received supervision and yearly appraisals but had not received training in risk assessing, mental health awareness and managing behaviours that challenge the service. Staff required this training to undertake their role.

People received support to access appropriate health and social care services and with their nutritional intake. We found people had person centred plans but there was little exploration of people’s diversity needs and we found no end of life wishes recorded. We found there was a variety of both group and individual activities for people to undertake throughout the week.

People told us they could raise complaints and that concerns raised where responded to appropriately. We found the service had a robust complaints procedure and reviewed complaints to identify trends.

People and staff said the registered manager was supportive. We found the service encouraged feedback from people through reviews and yearly surveys.

Auditing had taken place but had failed to identify all the concerns and address issues in a timely manner.

We found 4 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulations

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

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. Training records showed that most staff had completed safeguarding adults training within the last six months.

There were effective recruitment and selection processes in place, and staff had been through induction and shadowing before starting work. This ensured that the staff were of good character and were competent enough to meet the care and welfare needs of people.

Is the service effective?

People's health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in the care planning process and that they were happy with the care that was provided.

Is the service caring?

People were supported by kind and attentive staff. People told us that care workers showed patience and gave encouragement when supporting people. One person told us, 'nothing is too much trouble for them.'

People using the service, and their relatives, were contacted regularly to check if they were satisfied with their care. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People's needs had been assessed before they moved into the scheme. People had access to activities that were important to them. People knew how to make a complaint if they were unhappy. The provider had a robust complaints procedure that was accessible to people who use the service.

Is the service well-led?

Staff told us that the management team was "always routing' for people who used the service and "responded very quickly.'

Staff told us they were very happy with their managers, "she is good at providing support whenever you need it.'

Another person told us " she is very involved and I have a lot of confidence in her.'

Staff were clear about their roles and responsibilities, and had a good understanding of the ethos of the agency, quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at three care plans and saw that people's needs had been assessed before they started receiving services and that this assessment involved social workers and other professionals.

The service had a safeguarding policy and procedures to follow if abuse was alleged or suspected. Staff we spoke had an awareness of safeguarding policies and procedures. They had received training in safeguarding of vulnerable adults.

Staff received appropriate supervision and appraisal. We saw that in addition to annual appraisals, formal supervision meetings took place approximately every eight weeks. Staff we spoke with said that they had been supervised and felt supported in their work.

The provider told us that a tenant meeting took place approximately every eight weeks to discuss people's issues and concerns. We looked at the minutes of the last meeting (March 2013) and saw that the group discussed a number of issues including restaurant renovations and the introduction of a new on-site advocacy service.