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Index Care 88 Abbey Wood Road Good

Reports


Inspection carried out on 17 August 2017

During a routine inspection

This inspection took place on 17 August 2017and was unannounced. At our last inspection on 01 September 2016, we found improvements were needed in relation to medicine room temperatures not being monitored and documented and the service did not have a medicine fridge. Systems in place to audit and check the service were not entirely effective as issues found at the inspection had not been identified by the provider.

At this inspection on 17 August 2017, we found improvements had been made in relation to medicine room temperatures were monitored and documented on a daily basis and there was medicines fridge available should it become necessary for medicines to be stored in the fridge.

88 Abbey Wood Road is a service which provides care and support for up to seven people with mild/moderate learning disabilities. There were seven people using the service at the time of our inspection.

The service had a registered manager who had been in place since February 2016. 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.

Appropriate safeguarding adult's procedures were in place and staff knew and understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Risks to people were identified and monitored and provided clear information and guidance for staff on how to support people. Medicines were stored, administered and recorded appropriately. Appropriate recruitment checks were carried out before staff started work. The provider had carried out appropriate pre-employment checks to ensure staff were suitable and fit to support people using the service. There were enough staff deployed to meet people's care and support needs. Accidents and incidents were recorded and followed up in a timely manner.

Staff received appropriate training and support to carry out their roles and staff training was up to date. Staff received regular supervisions, appraisals. There were processes in place to ensure staff new to the service were inducted into the service appropriately. The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005(MCA). Staff asked people for their consent before they provided care. People were supported to have a balanced diet. People had access to a range of healthcare professionals when required in order to maintain good health.

People said staff were kind and caring and their privacy and dignity was respected. People were encouraged to be as independent as possible.

People were involved in their care planning which was person-centred and identified people’s needs, choices and preferences. Care plans provided clear guidance for staff on how to support people in line with their individual needs. People participated in a range of personalised activities which protected them from social isolation. Regular service user meetings were held to obtain people’s feedback. People knew about the complaints procedure and said they would use it complain if they needed to.

There were effective processes in place to monitor the quality and safety of the service. People’s views had been sought about the service to help drive improvements. Regular staff meetings took place and the service sought people’s feedback about the service. People and staff were complimentary about the service and the registered manager.

Inspection carried out on 1 September 2016

During a routine inspection

This comprehensive inspection took place on 01 September 2016 and was unannounced. 88 Abbey Wood Road is a service which provides care and support for up to seven people with mild/moderate learning disabilities. There were five people using the service at the time of our inspection.

There was a new manager who had been in place since February 2016 and has applied to be the registered 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.

At the last comprehensive inspection on 05 February 2016 we had found serious breaches of regulations in respect of people's safe care and treatment, staffing, staff training, people's records and arrangements to monitor the quality of the service. The service was rated Inadequate overall and placed in special measures. We imposed a condition on the registration of the service, that the provider submitted monthly audits in respect of medicines and hot water temperatures. The provider sent us an action plan on 27 April 2016 telling us what actions they would take to address these breaches and submitted the monthly audits as required. This report only covers our findings in relation to the latest inspection. You can read the report from our last inspections in February 2016, by selecting the 'all reports' link for 88 Abbey Wood Road on our website at: www.cqc.org.uk.

We carried out this inspection on 01 September 2106 in line with our special measures policy to check if improvements had been made. During this inspection we found the provider, manager and staff had worked hard to address the previous breaches to ensure that people's needs were met. Improvements had been made in all areas and the service. The service will now be removed from special measures but we have rated the service as 'requires improvement' because it is too early to be certain the service will maintain full compliance in the future. We also judged that the condition we imposed on the provider’s registration is no longer required and will be removed. We will continue to monitor the service until we are satisfied the good practice found during this inspection has been embedded and maintained.

At this inspection we found significant improvements had been made in relation to people's safe care and treatment, staffing, staff training, people's records and arrangements to monitor the quality of the service. Staff told us there were considerable changes in the home and both staff and people who used the service were all positive about the new manager at the home.

There was one area that needed further improvement in that medicine rooms temperatures were not being monitored and documented and the service did not have a medicine fridge.

We found medicine risks to people were identified assessed and monitored and there was guidance for staff to reduce risks. Work to address the risks associated with ineffective water temperature controls had been carried out. There were systems in place to ensure that water temperatures were maintained under the recommended safe maximum temperature of 44 degrees centigrade. Accidents and incidents were logged and followed up in a timely manner Staff training was up to date and staff received appropriate support through formal supervisions. Systems were in place to monitor the quality and safety of the service but these required some improvements. People’s views had been sought about the service to help drive improvements.

Inspection carried out on 5 February 2016

During a routine inspection

This inspection took place on 5 February 2016 and was unannounced. This was the first inspection at the home.

88 Abbey Wood Road is a care home which provides care and support for up to seven people with mild/moderate learning disabilities. There were five people using the service at the time of our inspection.

There was a new manager, who has applied to be the registered manager, in place since two days prior to the inspection in February 2016. 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 a number of breaches of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014.

People’s safety had been compromised in that medicines were not managed safely. Risks to people had not always been identified or properly assessed, and action had not always been taken to manage risks safely. CQC is considering the appropriate regulatory response to resolve the problems we found. We will report on any action taken when it is completed.

Systems were not in place to monitor and evaluate the quality and safety of the service and regular feedback was not sought from people who used the service, relatives, staff or health care professionals in order to improve the service. CQC is considering the appropriate regulatory response to resolve the problems we found and will report on any action taken when it is completed.

Staff had not received up to date refresher training. Staff had not received appropriate support through formal supervisions. You can see what action we have told the provider to take at the back of the full version of this report.

Appropriate recruitment checks took place before staff started work. There were enough staff to meet people’s need. Safeguarding adults procedures were robust and staff understood how to protect the people they supported from the risk of abuse. The service had a whistle-blowing procedure which was available to staff, and staff said they would use it if they needed to.

People, their relatives and healthcare professionals were involved in their care planning. Support plans provided some information and guidance for staff on how to support people using the service. However, improvement was required because they had not always been updated to reflect people’s changing preferences. People had access to a range of healthcare professionals when required. People were supported to have a healthy and balanced diet.

The manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff treated people with kindness and compassion; while respecting their privacy and dignity. Each person had a key worker assigned to them to give individual and focused support. Staff knew people well and remembered things that were important to them so that they received person-centred care.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to consider the process of preventing the provider from operating this service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not