Archived: Respond

A manager was in post and was registered with us since October 2010. 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 and associated Regulations about how the service is run.

The 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 difficulties and autism using the service can live ordinary a life as any citizen.

At our previous inspection on 13 and 14 January 2016 we found a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009. We asked the provider to take action to make improvements in the key question of well-led. This was because the service did not notify us without delay of DoLS authorisations approved by the supervisory body and safeguarding alerts raised with the local authority. We asked the provider to send us an action plan to show the what improvements would be made, by 28 March 2016. The provider failed to submit the action plan.

During this inspection, we found the service still did not notify us of certain events. When notifiable safety incidents happened, the registered manager did not follow actions as required under the duty of candour regulation. Although relatives felt the service was well managed, we found a negative workplace culture amongst staff, who felt unsupported and not listened to. Governance and performance management systems were not always reliable and effective.

Staff were not appropriately inducted; trained and supervised. People’s personal safety had been assessed and plans were in place to minimise identified risks. We noted these were not always reviewed.

People were supported to have maximum choice and control of their lives. However, the service was not always compliant with Mental Capacity Act 2005 and its codes of practice, as some people were unlawfully deprived of their freedom.

Relatives were positive about the caring nature of staff. We heard comments such as, “Staff members are fantastic, wonderful, and very patient; I have never had any problems. They speak to my daughter as if she is a human being” and “I know the staff well and I trust them. My son comes back (home) very happy and is very comfortable at the unit and with all the staff. I think the unit has a homely feel.”

Staff knew people’s care and support needs. We observed they were very friendly, caring and had a very good rapport with the people they interacted with. Staff gave examples of how they protected people’s privacy, confidentiality and promoted their independence.

Relatives felt their family members were kept safe from abuse. A relative commented, “Once there was bruising and staff phoned straight away to find out if I was aware, which I was and I know she gets bruises when she rides the cycle.”

Staff knew how to protect people from harm. There were sufficient numbers of suitable staff to care and support people to stay safe and robust recruitment practices were in place to ensure people. Medicines were administered safely. There was some confusion regarding medicines as two different systems were in use. We have made a recommendation about medicines management.

People’s nutritional and health needs were met.

Relatives felt the service was responsive to people’s needs. Plans of care were person-centred to ensure they met people’s specific needs. The service was compliant with the accessible information standard (AIS) to ensure people with a disability or sensory loss can access and understand information they are given. Relatives knew how to raise concerns but felt there were no need to as any concerns raised were dealt with promptly.

We found six breaches in the regulations as a result of this inspection. You can see what action we told the provider to take at the back of the full version of this report.

Respond previously operated eight beds but from the 1 October 2014, this was reduced to four beds. There is currently a review of the service provision by Slough Borough Council.

The registered manager has been in post since October 2010. 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 and associated Regulations about how the

service is run.

Relatives gave positive feedback when discussing the caring nature of the staff. They told us staff was caring, kind and respectful. We heard comments such as, “X loves them (staff) and they care for X” and “Staff are kind and respectful towards X.”

Staff displayed patience, kindness and warmth towards people throughout our visit.

Relatives felt staff were experienced and skilled to provide care and support to their family members. Comments included, “They (staff) do their jobs very well” and “Based upon telephone calls from staff, they seem to know what they’re talking about.”

People were treated with respect and their dignity was preserved.

Relatives said the care provided focused on their family member’s individual needs. A review of care plans and risk assessments showed they were regularly reviewed and kept up to date.

Relatives felt confident the service ensured their family members were cared for in a safe manner. People were protected from abuse because staff was well-trained and fully understood their responsibilities in regard to safeguarding. Examples given of when they had dealt with safeguarding issues and the actions they had taken, was found be in line with the service’s safeguarding adult’s policy and procedures.

The service did not notify the Care Quality Commission (CQC) of certain incidents, within required time frames, which had occurred during or as result of provision of care and support to people.

Safe recruitment processes and checks were in place. We noted no additional staff members had joined the service since our last inspection.

The registered manager informed us due to a review of service provision by the Local Authority recruitment had been placed on hold since October 2014. The service currently had seven staff to provide care to four people. A family member commented, “They (staff) make sure there’s enough staff as X can display challenging behaviour.” Staff told us even with the decrease in staffing levels they found the workload manageable. Staff rosters supported what staff had told us.

People were given their medicines safely by appropriately trained staff. Staff records showed ‘medication staff competency records’ and medicines training was up to date.

Staff had received Mental capacity Act 2005 (MCA)and Deprivation of Liberty Safeguards (DoLS) training. They demonstrated a good understanding of the act and knew whether people had the capacity to make informed decisions and if not, what practices and procedures they should follow. This was also recorded in people’s care records to ensure staff acted in accordance with the requirements of the MCA.

Relatives said they knew how to raise a complaint but had no concerns about the service. A review of the complaint log showed complaints received was responded appropriately by the service to the complainants’ satisfaction.

The service provided support to enable people to have access to healthcare services. Staff spoke about the types of health care professionals they had access to. Comments included, “We have easy access to nutritionists. If we require additional support and if people acquired pressure sores, district nurses will visit to attend to their wounds.”

Relatives were overwhelmingly positive when discussing how well the service was managed. Staff said the manager was very supportive. Comments included, “The manager has an open door policy, he supports us and gives us the opportunity to think for ourselves but will always be there to guide us. He promotes self-worth and listens to us.”

Quality assurance systems were in place to improve the quality and safety of people who used the service. The service ensured the quality systems in place were reviewed for their effectiveness.

We found a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

People had clear aims for the time they spent at this service, were encouraged to increase their independence and skills, and supported to attain personal goals wherever possible.

There was a friendly atmosphere in the service that people responded favourably to. All staff interactions were patient and respectful. People were relaxed with staff. Staff listened patiently to people and showed they respected their opinions.

The service ensured people were kept safe at all times. There were policies and procedures in place that kept people safe. Staff were knowledgeable and confident about their safeguarding responsibilities.

There was an ongoing system of quality assurance that monitored and looked to improve all aspects of the service wherever possible.

One person we observed, was very upset after an encounter with a member of the general public. The manager took them to a place of privacy listening to their complaint, using sensitive and reassuring words which calmed them down. This showed people's privacy was respected. We spoke to people about whether they were being treated with dignity and respect one person said, 'They treat me good.'

People or carers acting on their behalf, were able to communicate what support they needed, their preferences and how it was going to be delivered. People had a programme of care; this encouraged and supported people to make meaningful use of their time. We saw programmes of care that focused on what people wanted to achieve.

We saw that people were encouraged to be as independent as possible.

We saw safeguarding policies and procedures were up to date and in place with the appropriate contact details for the local authority safeguarding team. There was an easy read guide about protection from abuse for people using the service.

One member of staff told us, 'The induction helped me to understand the culture of the service.'

We saw that staff and management worked together in monitoring the service's performance.