John Cabot House

The inspection took place on 22 August 2018 and was unannounced. At our last inspection in July 2017 we had found one person’s apartment had no working lighting. The provider had not acted to resolve this within a suitable timescale.

We had found there was not always sufficient skilled and experienced staff to provide support to people. Also, there had been a lack of staff training to effectively meet people’s needs. Some people had told us they felt some staff were not kind and caring in manner towards them. One person at our last inspection had not been out from the home for nearly three weeks. This conveyed they were not being fully supported with community based activities at that time. Finally, we had found that action had not been taken to address the concerns and shortfalls that had been picked up at our inspection at that time. This had meant that the quality checking systems at that time were not fully effective.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions is the service safe? is it effective? is it caring? is it responsive? is it well led? to at least good.

There was a registered manager for 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 this inspection we found that actions had been taken to address the shortfalls that we found at our last visit. We saw that rooms were safe because they all had working lighting. The provider had put in place a robust checking system. This was to ensure any environmental health and safety matters were reported and addressed swiftly.

There were now sufficient skilled and experienced staff to provide effective support to people. There was also a full training programme for staff in place to effectively meet people’s needs.

People told us that all the staff were kind and caring in manner towards them. We also saw that the team on duty all conveyed a warm, positive and caring approach to the people they supported.

At this inspection there was clear evidence that all people who wanted too, were well supported to go out from the home daily. This showed that people were now well supported with community based activities.

We also found that actions were taken to address any concerns and shortfalls in the service. This showed that the provider's quality checking systems were now up to date and effective.

People said that the staff that supported them were always kind and caring in manner. People at the home engaged with staff in a positive way with the staff who provided them with personal care and other support.

People spoke highly of the food they were supported to prepare and cook. Staff encouraged people to build up independence in their daily living skills.

People's legal rights were being respected. Staff understood the need to seek consent before all care was offered to people. The staff also understood the basic principles of the Mental Capacity Act 2005. Staff knew people had the right to make unwise decisions in their dally life.

The team of staff and the people we met told us they now felt supported by the registered manager, senior staff and senior managers.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 carried out an unannounced inspection of the service on 19 and 20 July 2017. This meant the provider and staff did not know we would be arriving.

At our last inspection in March 2016 we rated the service overall as Requires Improvement. We did not identify any breaches of the Health and Social Care Act 2008 at that inspection.

During this inspection we found one person’s apartment had no working lighting. The provider had not taken action to resolve this within a suitable timescale. They had not informed the Commission of this as required by law.

Staff had not received the training required to effectively meet people’s needs.

People were not always treated with dignity and respect.

Care records kept did not provide an explanation of why planned activities had not taken place

We identified that on one recent occasion staffing levels had been less than those identified by the provider as required to meet people’s needs.

There were no recorded complaints in the 12 months leading up to our visit. However, we were made aware of concerns people had shared with staff and managers.

Feedback from staff regarding the leadership and management of the service was not always positive.

Risks were assessed and plans put in place to keep people safe. Checks were carried out on staff before they started work with people to assess their suitability to work with vulnerable people. Medicines were safely managed and people received their medicines as prescribed.

Staff received regular supervision with their line manager. Arrangements were made for people to see healthcare professionals including a GP when they needed to do so. The service complied with the requirements of the Mental Capacity Act 2005 (MCA).

People were cared for and supported by staff who knew them well. People’s individual care and support plans were person centred and detailed the information required to provide their care and support. Staff worked positively with other professionals and implemented plans developed by them.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found one breach 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 the report.

John Cabot House is registered to provide accommodation and personal care to eight people. Two people are accommodated in self-contained flats and up to six people can be accommodated in the main house which has six en-suite bedrooms. The service specialises in providing care for people with an acquired brain injury. There were seven people using the service on the day of our visit

The registered manager for the service had recently left and the provider was in the process of advertising for a new 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.

Staff had been provided with training and supervision to help them to care for people and meet their needs. However, this had not been kept up to date and some staff had not had recent training. Staff supervision had not been carried out as often as the provider’s policy stated it should be. This meant people were supported by some staff who were not well supported and were in need of further training.

Medicines were mostly managed safely however staff did not always follow the provider’s policy when writing out hand written medicines records. They were not always doing this with two staff checking to make sure they were accurate. This meant without the safety check of two staff there could be a risk that people’s medicines may not be given to them correctly.

There were systems in place to minimise risks to people and to protect them from abuse. People told us that the staff who assisted them were always kind and caring in manner. People at the service interacted in a positive way with the staff who provided them with personal care and other support.

People were assisted with their needs by staff who understood their needs and knew how to provide effective care. Staff were kind and caring toward the people they supported. They ensured that people's privacy and dignity was maintained.

People spoke highly about the care and support they received from the staff. Their comments included, "They have pushed me to be more independent which is a really good thing” and “I have found them all most helpful".

Care records were informative and clearly showed what to do to effectively assist people with their range of needs.

People were well supported to make complaints about the service provided if they needed too.

Staff had a good understanding of the provider’s visons and values; a key one being to provide personalised care. We saw that they put these into practice in the way they supported people at the home.

In the absence of a registered manager, the deputy manager was being well supported by a registered manager from another service run by the provider. They were providing management support on a daily basis.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, 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 told us they felt safe at the home and with the staff who assisted them there. People were protected by safeguarding procedures that contained up to date guidance. The staff knew how to safeguard people and have been on training to help them to understand what abuse was.

We observed interactions between people at the home and the staff that were positive. They showed us that staff were attentive to people's needs. For example staff were heard prompting people and reminding them about personal matters in a discrete way.

Peoples rights were protected and restrictions on their liberty were only imposed when necessary for their safety to be maintained. A completed DoLs application had been made by the service due to one person's complex needs. We saw that robust steps had been taken to ensure that the rights of the person concerned were upheld. We also saw that care records clearly set out how to ensure that there were minimal restrictions to the person's liberty while this DoLS application was in place.

People were assisted with their needs by staff who had been on a range of training and learning opportunities. Staff were also properly supported in their work to ensure they provided safe and suitable care.

Is the service effective?

The four people we spoke with told us they were satisfied with the care and support that they had received at John Cabot House.

Staff were observed providing assistance to people in a calm and attentive manner. We saw staff spent time with people who needed support. This was due to their particular needs that were acquired as a result of their brain injury. Staff prompted people in a discrete and respectful way when their memory loss impacted on their ability to recall things.

People were assisted with their needs by staff who understood how to support people effectively. The staff had an insight and awareness of how an acquired brain injury impacted on people's life.

Care plans and risk assessments were detailed and informative. They explained how to support people with their needs which were as a result of their particular acquired brain injury. For example, care plans included detailed guidance and strategies for staff to apply to be able to safely support people. The staff told us they used these approaches and they were effective ways to respond when people's mood and behaviours changed.

Is the service caring?

People who used the service were observed being supported with their needs by staff who were respectful and attentive in manner to them. Staff were also patient in approach when they assisted people whose memory problems meant, they needed regular prompting about certain matters in their life.

The staff demonstrated they understood how to support people with their complex needs. The staff we spoke with also had insight into the impact that an acquired brain injury could have on people in their daily life.

We also observed that there was an open culture at John Cabot House. This enabled people to make their views known in an informal way if they preferred to. We saw that people spoke with staff at any time that they wanted to.

Is the service responsive?

The staff we spoke with understood how to obtain consent before they assisted people with their care. Where people were not able to give informed consent there were systems in place to ensure their rights were protected.

Staff were provided with suitable training to ensure that they were able to safely respond to potentially violent and aggressive incidents. The training enabled staff to use non-confrontational techniques.

There was a system of staff supervision that ensured that the staff teams performance and development was properly monitored. Where staff required additional support, for example after an incident or occurrences this was provided. Time was taken to ensure that staff were properly supported if they had responded to behaviours that were particularly challenging for them.

Is the service well-led?

People who used the service were asked for their views about their care and treatment and they were acted on. There were systems in place to ensure that the views of people who lived at the home were regularly sought and acted upon.

We saw that regular 'house meetings' were held at the home. The minutes confirmed people's views were sought about the way the home was run and about their views of the care and support that they were receiving.

There was a suitable process in place for effectively reviewing and evaluating incidents and accidents which involved people at the home. An online reporting system ensured that all incidents including ones where people had shown behaviours that were challenging were properly reviewed. Senior managers also monitored this information and acted upon it where necessary.