Background to this inspection
Updated
3 August 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on the 20 June 2016 and was unannounced. The inspection team consisted of one adult social care inspector from the Care Quality Commission (CQC).
We asked people, their relatives and health care professionals for their views about the service and facilities provided. During our inspection we spoke with the following people:
• One person who attended Wigan Respite service.
• Four relatives of people who accessed the service by telephone
• 6 members of staff, which included; senior service manager, current registered manager, manager and three support workers.
We looked at documentation including:
• Two care files and associated documentation
• Staff records including staff rotas, recruitment, training and supervision
• Three Medication Administration Records (MAR)
• Audits and quality assurance
• A variety of policies and procedures
• Compliments/complaints received
Before the inspection we reviewed the information we held about the service. This included notifications regarding safeguarding and incidents, which the provider had informed us about. A notification is information about important events, which the service is required to send us by law.
We liaised with the local authority before our inspection and they informed us that the service was undergoing a further change in management. We established that this had resulted in some procedural changes which had caused some disruption to the service and staff to leave.
Updated
3 August 2016
Wigan Respite Service, known internally as ‘the bungalow’ provides respite accommodation and personal care for up to 4 people at any one time. The service currently has 25 people who access Wigan Respite service. This inspection was unannounced and carried out on 20 June 2016. This was the first inspection at the current location.
Due to people’s complex needs, we only spoke to one person who accessed the service at the time of the inspection. We spoke with four relatives of people who used the service and one health care professional. We received mixed views about the quality of the service and the way it was run.
During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; Person-centred care and Good governance. You can see what action we told the provider to take at the back of the full version of this report.
The service is required to have 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.
At the time of the inspection, the service was undergoing a change in management which meant there had been three providers in the past year. We received a mixed response regarding whether staff felt supported in their role and ascertained the staff team felt there was ambiguity in the management structure which had caused the team to be fragmented. We found the management to be transparent and honest regarding the current position of the respite service and they identified clear plans in achievable timeframes to progress the service.
The people we spoke with told us they felt comfortable and safe at the service. The staff we spoke with had a good understanding about safeguarding and whistleblowing procedures and told us they wouldn’t hesitate to report concerns. People were protected against the risks of abuse because the service had a robust recruitment procedure in place.
We saw appropriate arrangements were in place for the management of medicines. Systems were in place to manage and reduce risks to people. In people's care files we saw comprehensive risk assessments and care plans to mitigate risks.
People's families and advocates were instrumental in decision making when people lacked capacity but the service was not working within the legal requirements of the Mental Capacity Act (2005) (MCA). The registered manager acknowledged that this was an area for improvement and was liaising with the local authority to address this.
The service had a training matrix to monitor the training requirements of staff. Staff received appropriate training, supervision and appraisal to support them in their role.
People's nutritional needs were met depending on their individual assessed needs and people told us they were offered choice at mealtimes and were supported to make their own snacks.
People were supported by staff that were compassionate and treated them with dignity and respect. People and their relatives told us the staff promoted people’s independence as much as possible. People told us that staff provided choices and we ascertained people felt empowered to make their own decisions.
We received some concerns from relatives and a health care professional regarding the level of support provided to people in relation to their self –care and that on occasions it had been reported that people had left the service unshaved, with toothpaste residue around their mouth or teeth not cleaned.
The service had an appropriate complaints policy in place and relatives told us they were aware of the complaints procedure. We saw complaints had been followed up by the service but two relatives told us there complaint was ongoing and had not been rectified.
The biggest concern expressed centred around the current booking system to schedule a respite stay. We were informed the current system was not working and that bookings had been changed at short notice.
We saw quality audits were undertaken and satisfaction surveys were sent to establish people’s view to improve the service.
The management acknowledged there had been significant changes to the leadership in a short space of time and that there hadn’t been consistency with supervision, team meetings, training and sickness management. Staff were open and insightful regarding the recent challenges but we found them to be motivated to work with the manager to improve the service and their commitment to the people that accessed the service was evident throughout our inspection.
The overall re-rating for this provider is ‘Requires improvement’ but there were domains rated as good and we acknowledge the commitment shown by the management to address other areas throughout the inspection.