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Inspection Summary


Overall summary & rating

Requires improvement

Updated 8 August 2018

Angela House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Angela House is registered to provide care and accommodation for up to six adults with a learning disability or autistic spectrum disorder. At the time of this inspection there were four people living at the service, each with their own bedroom. The accommodation comprises a communal lounge, kitchen diner, a sensory room, a small rear courtyard, and communal bathrooms and toilets. The bedrooms do not have ensuite facilities. The house is located in a central part of Hammersmith close to a wide range of amenities, public transport and a large park. This care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This comprehensive inspection was conducted on 15 and 21 March, 5 April and 14 May 2018. The first day of the inspection was unannounced and we advised the manager of our plan to return on the second day. We visited the provider’s main office on 5 April 2018 in order to check staff recruitment files and also met with senior management staff at the main office on 14 May 2018, as they wished to discuss matters that had arisen about the service. During the inspection we received information of concern from an external source which alleged concerns regarding to the safety and welfare of people who used the service. There were specific allegations regarding the provider’s management of people’s finances. This information was also sent to the local authority, who met with the provider to discuss these allegations. The provider informed us that they asked the local authority to investigate these allegations through safeguarding procedures, so that an independent judgement could be reached. These safeguarding investigations were in progress at the time we concluded this inspection.

An immediate concern was also raised by the external source about the safety of a specialist bed and mattress allocated to a person living at the care home. This was addressed by a visit from a physiotherapist and occupational therapist employed by the local learning disability partnership. Following their visit, we received written confirmation from the professionals to confirm that the bed and mattress safely met the person’s needs. The external source has subsequently raised other issues to the local authority about the suitability of the bed and mattress.

At our previous comprehensive inspection on 30 January, 6 February and 16 March 2017 the service had an overall rating of Requires Improvement. We had rated effective, caring and responsive as Good, and safe and well-led were rated as Requires Improvement. A breach of legal requirements had been found in relation to staffing levels. Following the inspection the provider wrote to us to state what action they would take to meet the breach of legal requirement.

We undertook an unannounced focussed inspection on 13 October 2017 in order to check how the provider had met its action plan and report on our findings in relation to specific aspects of safe and well-led. We had also received information of concern from an external source prior to the inspection and these concerns were looked into as part of the inspection. Following the inspection visit we had received other information of concern from other external sources and returned unannounced to the service on 21 November 2017 to conduct a second day of this unannounced focussed inspection and look into the additional concerns which had been brought to our attention. We had found that although t

Inspection areas

Safe

Requires improvement

Updated 8 August 2018

The service was not always safe.

People were not consistently provided with a safe living environment.

A more robust approach was needed to ensure that obsolete medicines were promptly disposed of, in line with the provider’s agreed arrangements with the dispensing pharmacy.

Staff understood how to protect people from the risk of abuse.

There were sufficient staff deployed and people who used the service were protected by the provider’s detailed recruitment practices.

Effective

Good

Updated 8 August 2018

The service was effective.

There were appropriate systems in place to support staff with their training and development needs.

People were supported by staff to eat a balanced diet and meet their health care needs. The provider worked cooperatively with health care services.

Care and support was provided in accordance with the requirements of the Mental Capacity Act 2005.

The provider was making improvements to the premises to ensure that it met people’s needs.

Caring

Good

Updated 8 August 2018

The service was caring.

People received their care and support from kind and caring staff, who understood people’s unique background, needs and wishes.

The provider supported people to access advocacy services. Staff used creative ways to communicate with people, in conjunction with guidance from external professionals including psychologists and speech and language therapists.

Staff ensured that people’s dignity and privacy were respected.

Responsive

Good

Updated 8 August 2018

The service was responsive.

People’s needs were reflected in up to date care and support plans. New needs were assessed by external professionals and the staff team.

Staff supported people to take part in meaningful activities at home and in the community.

People who used the service and their representatives were provided with information about how to make a complaint, including information produced in an easy read format.

Well-led

Requires improvement

Updated 8 August 2018

The service was not always well-led.

The provider had addressed the areas for improvement in the previous inspection report. However, the issues of concern regarding the premises showed that more in-depth monitoring of the quality of the service was needed.

The management team at Angela House and other senior managers within the organisation had concentrated on improving staff morale through listening to staff and involving them in initiatives to develop the service. This work was still in progress.

The provider was keen to demonstrate its openness and integrity in response to any concerns made about management of the service and the care of people living there.

The service worked well with other organisations to improve the lives of people who used the service.