Background to this inspection
Updated
5 April 2018
This inspection took place on 6 November 2017 and was announced. The provider was given 24 hours’ notice as they are a small service for adults with learning disabilities and we needed to be sure people would be home during our inspection.
Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions. The provider had made some progress, but areas of the service had not yet improved to a good level and breaches of our regulations were still found during this inspection.
15 & 17 Chant Square accommodates up to eight people, seven of whom live in a downstairs fully adapted flat, one of whom lives a more independent lifestyle in the upstairs flat. 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 disabilities and autism using the service can live as ordinary a life as any citizen.
The inspection was completed by one inspector.
Before the inspection we reviewed the action plan the provider had submitted in response to the last inspection. We sought feedback from the local authority the home is based in. We reviewed information the provider had submitted to us in the form of notifications. A notification is information about important events which the service is required to send us by law.
During the inspection we made observations of care delivered to people as we were not able to communicate with them directly due to the complexity of their communication needs. We spoke with one relative who was visiting the home. We reviewed three people’s care files including care plans, risk assessments and records of care delivered. We looked at seven staff files including recruitment records of three staff recruited since our last inspection, supervision and training records. We spoke with the regional manager, the home manager, the team leader and two support workers. We also looked at various policies and procedures, audits, records and meeting minutes relevant to the management of the service.
Updated
5 April 2018
The inspection took place on 6 November 2017 and was announced. 15 & 17 Chant Square is a care home for adults with learning disabilities. It is divided into a ground floor flat for up to seven people and a first floor flat for one person who is able to live more independently. At the time of our inspection six people were living in the home.
15 & 17 Chant Square is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during the inspection.
The home did not have a registered manager. The service manager had applied to register and the home had been without a registered manager since July 2017. 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.
The home was last inspected in October 2016 when we identified breaches of regulations regarding person centred care, dignity and respect, safe care and treatment and good governance. We asked the provider to take action to make improvements. Although the provider had addressed specific concerns around choking, the mealtime experience and moving and handling equipment, breaches of regulations were found on this inspection.
We found care plans lacked detail regarding the specific nature of the support people needed and people’s preferences were not always clearly captured. Risks people faced had been identified, but the measures in place to mitigate them were not clear. Information for staff about how to support people to take their medicines was insufficient to ensure medicines were managed in a safe way. The manager had not responded to allegations of abuse in an effective or timely way. Staff had not received the training and support they needed to perform their roles. The governance and audit arrangements had failed to identify or address the range of concerns found during the inspection. Notifications were not being submitted as required.
We identified breaches of six regulations. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Staff had been recruited in a way that ensured they were suitable to work in a care setting. There were enough staff on duty to ensure people’s needs were met.
The home was clean and there were systems in place to ensure the prevention and control of infection.
Staff took appropriate action in response to incidents. However, it was not clear that the service took the opportunity to learn lessons following incidents.
People’s needs were assessed and care plans had goals in place. The home operated a keyworker system where a named member of staff took the lead on supporting an individual. Keyworkers met with people on a monthly basis to monitor their progress towards their goals.
The service had taken action to address our concerns about the mealtime experience and people were now involved in choosing their meals. We saw people were supported to eat in a safe way by staff who demonstrated a patient and kind attitude.
The home had recently been redecorated and was fully accessible to people who lived there. The bathrooms had equipment in them to ensure people were able to access them.
People were supported to attend healthcare appointments and staff recorded details of the advice given by healthcare professionals. However, the information about people’s healthcare needs was not always clear and consistent.
The service was working within the principles of the Mental Capacity Act 2005 and had made appropriate applications to deprive people of their liberty.
Staff had developed positive, caring relationship with people living in the home. We saw compassionate care and support being delivered by staff.
The provider had ensured the complaints policy was available in a format that was accessible to people living in the home. There had been no complaints about the service since our last inspection.
The provider had supported people and staff through a recent bereavement. However, people and their relatives had not been supported to consider their own end of life wishes.
There were house and staff meetings where people and staff were given the opportunity to be engaged with the development of the service.
The provider had a clear values structure which focussed on supporting people to be as independent as possible.
The overall rating for the service is Requires Improvement. This is the second consecutive time the service has been rated Requires Improvement.