Background to this inspection
Updated
15 March 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.’
This inspection took place on 2 December 2016 and was announced.
The provider was given 48 hours’ notice because the location provides a domiciliary care service we needed to be sure that someone would be in.
The inspection team consisted of two adult social care inspectors.
During the inspection, we spoke with the registered manager, the area manager, the quality manager, three support staff, and two people who lived at Latham court.
We looked at four people’s care plans and associated documentation, staff training records, supervision records, the incident and accident log and the management structure of the service.
Updated
15 March 2017
This focused inspection took place on 2 December 2016 and was announced.
A previous inspection had taken place in October 2016, and breaches of the health and social care act 2008 were found which meant that some of the people living at Latham Court were at risk of harm. The service was rated as ‘inadequate’ and placed into special measures.
We asked the provider to take action following our inspection. The provider sent us an action plan following the inspection setting out what improvements needed to be made. Furthermore, we requested that the provider updated us weekly of any incidents or accidents at the service.
This inspection was to check that the provider’s action plan had been implemented and to review their evidence. This inspection only looks at the serious concerns we found on our inspection in October 2016 and whether the provider had completed the actions required to ensure these breaches were met. This means we have only looked at four out of the five inspection domains, whether the service is ‘safe’ ‘effective’ ‘responsive’ and ‘well-led.’
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Latham Court' on our website at www.cqc.org.uk.
The service was an Extra Care Living Scheme. A housing association held the tenancy agreements with the people who lived there, some of whom were being provided with care by Comfort Call Limited. At the time of our inspection there were 33 people receiving care packages from the service. There was one staff member present at night time and an alarm system in place for people to raise the alarm if they needed emergency assistance.
There was a registered manager in place at the time of the inspection. 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. Since the inspection we had been informed they have left their position.
During our inspection in October, we found concerns regarding the safeguarding of some of the vulnerable people who lived at the scheme. We found that some people were at risk of self-neglect and this was not always documented appropriately by the staff on shift. The provider was in breach of regulations associated to this. We asked the provider to send us an action plan detailing the action they were going to take The provider had detailed in their action plan what action they had taken to address these concerns, which we checked during this inspection. We saw during this inspection that new paperwork and risk assessments had been introduced for the people identified as being at risk, and the provider showed us how they had adopted this approach into their documentation for the future. We saw that adequate steps had been taken to ensure staff complete records appropriately, and all incidents had been reported as requested. The provider had adhered to their action plan and were no longer in breach of regulation.
During our inspection in October we found that incidents and accidents were not always being recorded appropriately by staff and analysed by the registered manager, which meant that this information was not able to be analysed for any emerging patterns or trends. We asked the provider to send us an action plan detailing the action they were going to take The provider had detailed in their action plan the action they were going to take and we checked this as part of this inspection. We saw during this inspection that the provider had re-evaluated their approach to incident reporting. We had been updated regarding any recent incidents and accidents at the service, and saw the provider had taken the correct action. The provider had adhered to their action plan.
We found during our last inspection that risk assessments were not always being reviewed. We identified the provider was in breach of regulation associated to this. We asked the provider to take action this to ensure that all risk assessments were reviewed in a timely manner, and in accordance with any changing needs that the person had. We asked the provider to send us an action plan detailing the action they were going to take. The provider had detailed in their action plan the action they had taken and we checked this during this inspection and found that people’s risk assessments had been reviewed and re-written to encompass any changing need. The provider had adhered to their action plan and were no longer in breach of this regulation.
We found during our inspection in October 2016 that the service was not always applying the principles of the Mental Capacity Act 2005, (MCA). We identified the service was in breach of regulation associated to this. We asked the provider to provide us with an action plan of how they were going to ensure the principles of the MCA were applied to people living at scheme who lacked capacity to make their own decisions. We saw during this inspection that the provider had addressed capacity and consent with everyone living at the scheme and had devised new paperwork in each person’s care plan to determine what decisions people could make for themselves, and where best interests decisions would have to be applied, specifically with regards to medical conditions and potential safeguarding concerns. We found some inconsistencies in one of the care plans we viewed, which we highlighted to the registered manager, and they addressed this straight away. The provider had adhered to their action plan, and they were no longer in breach of this regulation.
We found during our inspection in October 2016 that there was not always detailed information in people’s care files concerning their backgrounds, personal care needs and choices. We identified that the provider was in breach of regulation associated to this. We asked the provider to send us an action plan detailing the action they were going to take. The provider’s action plan detailed the action they had taken to address this, and we checked it as part of this inspection. We saw that the provider had taken action the address the issues that we found, and care plans contained more person centred information, such as people’s likes, dislikes and their backgrounds. We also saw that the provider had included in people’s care plans whether they wished to be supported by a male or female carer. We found during our inspection in October people were not always given this choice. The provider had adhered to their action plan and they were no longer in breach.
We found during our last inspection in October 2016, staff did not always have the correct skills and knowledge to support to support people around their mental capacity, best interests and safeguarding. We identified a breach of regulation associated to this. We asked the provider to send us an action plan detailing what action they were going to take. The provider’s action plan described the action they had taken between October 2016 and this inspection, and we checked this as part of this inspection. We found that the provider had adhered to their action plan and staff had completed ‘themed’ training and supervision with particular emphasis on the Mental Capacity Act 2005 and safeguarding.
During our last inspection in October 2016 we raised some concerns regarding the management structure at Latham court as the registered manager was not always on site, and we were concerned that the scheme manager was not adequately supported and did not have a good enough oversight of the scheme. We identified a breach of regulation associated to this. We asked the provider to send us an action plan detailing the action they were going to take. The provider discussed a new management structure with us during this inspection, which included a new management post created specifically to support the scheme manager.
The service was managed day to day by a scheme manager and a registered manager who was responsible for undertaking supervisions with staff, overseeing the care delivery and reporting to an Area Manager. The provider had adhered to their action plan and were no longer in breach of this regulation.
The rating for the service was no longer inadequate. This was because the provider adhered to the action plan in respect of the serious concerns identified at the last inspection. We will review the rating for the service in full at the next comprehensive inspection.