Background to this inspection
Updated
10 February 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.
The inspection took place on 31 October 2016 and was unannounced. The inspection was carried out by one adult social care inspector.
Prior to the inspection we reviewed information we held about the service. This included notifications the service is required to send us about safeguarding, serious injuries and other significant events. We also reviewed any feedback on the service provided to us via our online ‘share your experience’ forms since our last inspection.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information contained in the PIR and used it to help plan our inspection.
We sought feedback about the service from the local authority quality assurance team, Stockport safeguarding, Stockport Healthwatch and other professionals the provider had given us contact details for. Stockport Healthwatch shared general comments made about the provider in questionnaires they had received, and a community nurse with previous involvement with the service provided us with positive feedback on the service.
During the inspection we spoke with one person who had stayed at the service the previous night. There were no people using the service present during the majority of our inspection. We attempted to contact some people who used the service and would be able to speak with us by phone following the inspection, but were unsuccessful in our attempts. We spoke with the acting manager, a deputy manager from the sister short-breaks service and two support workers. We also spoke briefly with the Chief Executive Officer (CEO) for Independent Options who visited Beech Avenue during our inspection. Following the inspection we spoke with a further four support workers and four relatives/carers by phone.
We reviewed records relating to the care and support people were receiving. This included handover records, daily records, four care plans and four medication administration records (MARs). We looked at records related to the running of the service, including records of servicing and maintenance, the provider’s quality assurance audits and records of staff training and supervision.
Updated
10 February 2017
This inspection took place on 31 October 2016 and was unannounced. We last inspected Beech Avenue on 29 October 2013 when we found the service was meeting the requirements in relation to all regulations inspected.
Beech Avenue provides a short breaks service to people (guests) who have a learning and/or physical disability. People supported by the service usually lived with a family member or shared lives carer. In this report we have referred to both relatives and shared lives carers as ‘carers’.
The property is a four bedroom detached dormer bungalow. There are three bedrooms on the ground floor and one bedroom on the first floor. The home has gardens to the front and rear and has two shared bathrooms and an additional shared toilet. The home is located within the residential area of Gatley, Stockport. The home is close to the motorway and Gatley train station is nearby. At the time of our visit there had been three guests who had stayed the previous night. There was no-one using the service present during the day at the time of our visit.
There was an acting manager in place who was in the process of completing their application to register with the Care Quality Commission (CQC. 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.
We identified breaches of six of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to assessing and reducing risk, the safe management of medicines, assessment and care planning, complaints, governance, training and supervision, and meeting the requirements of the Mental Capacity Act 2005 (MCA). We also made a recommendation in relation to reviewing guidance on the implementation of the MCA. We are currently considering our options in relation to enforcement in relation to some of these breaches of regulation, and will update the section at the end of this report once any enforcement action has concluded.
We found care plans had been completed to a variable standard. Some care plans contained only limited information on preferences and support needs, whilst others contained more detail. Care plans had not been regularly updated to ensure the information they contained was still accurate.
One person’s care plan did not detail clear information about the support the person required to eat and drink. This person was also at risk of choking and this risk had not been reflected in their risk assessment.
We received mixed feedback about activities provided at the service. Some carers reported people enjoyed the activities and were given a wide range of opportunities. However, we saw feedback had also been given to the provider requesting more trips out.
Some people enjoyed the service for the social aspect of meeting friends. It had not always been possible for the provider to arrange visits so that people could stay with friends who also used the service. The acting manager told us they were reviewing the booking process.
The person we spoke with using the service told us they received a choice of meal. Staff did the shopping on a weekly basis to meet the dietary requirements and preferences of guests booked to stay that week.
There were no clear instructions in place for staff to follow in relation to the administration of ‘when required’ (PRN) medicines. We also found one person who was prescribed a medicine for use in emergency situations did not have the required care plan in place to inform staff when they should administer this.
The provider had submitted applications to the local authority to deprive people of their liberty. It appeared a ‘blanket approach’ may have been taken to this without consideration of whether people were able to make their own choice about whether they stayed at the service.
We found evidence of the use of restrictive practices to keep a person safe. However, there was no evidence in the care plan that this had been considered as part of a best interests decision as is required under the MCA.
There was a small staff team and people who used the service regularly got to know the staff supporting them. Carers told us their family members felt comfortable with the staff supporting them.
Training was provided in a variety of topics. However, refresher training was overdue in some subject areas including epilepsy. One carer commented that staff did not seem to effectively identify when their family member had seizures. There were gaps in the provision of supervision to staff.
The provider sought feedback from people using the service and their carers. Questionnaires had been sent to people and carers and there were various groups and committees in place to ensure people, carers and staff had a say in the development and improvement of the service.
The service had investigated formal complaints. However, we found a concern raised by a relative had not been handled appropriately by a former manager and had not been investigated.
A range of audits and checks were completed by the manager and provider. These covered a wide range of areas. However, actions were not always completed in a timely manner and these systems had not been effective at ensuring the issues we identified had been addressed.
Staff felt motivated and valued in their roles. The acting manager also told us they felt the organisation was supportive of them. The acting manager had identified some of the areas where improvements were required prior to our visit and was taking actions to address these shortfalls.
We received positive feedback from a health professional with involvement in the service. They told us they found staff professional and said they had found the service provided to be excellent.