Housing 21 - Belsize Court

Housing 21 – Belsize Court is an extra care service providing personal care to people living in their own flats within Belsize Court in Sutton centre. At the time of the inspection 30 people were receiving personal care, most of whom were older people and required support to remain as independent as possible. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People received the right support in relation to risks and these were assessed appropriately with guidance for staff. There were enough staff to support people safely and in a timely manner. The provider checked staff were suitable to work with people through recruitment checks. Staff received training in infection control practices, including the safe use of personal protective equipment (PPE). The registered manager was reviewing medicine systems with support from the local authority pharmacist to reduce the number of errors. People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

The registered manager and staff understood their role and responsibilities. The registered manager engaged and consulted well with people using the service and staff. Staff felt well supported by the registered manager. The registered manager understood their responsibility to notify CQC of significant events as required by law. The registered manager had good oversight of the service and a good understanding of areas for improvement. They had a clear action plan in place to make these improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 2 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At this inspection we found the provider had embedded the required changes into practice and sustained the necessary improvements. We have therefore improved the overall rating to Good.

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service.

People using the service lived in their own private flats in a large purpose-built building within the town of Sutton. Belsize Court has a total of 63 flats for people aged 55 years and older.

Not everyone using Housing and Care 21 – Belsize Court receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection the service was providing personal care to 58 people

The service is required to have a 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. The manager had started at the service in April 2018. At the time of our inspection visit the manager had made an application to become registered.

The provider had sustained improvements to the way they managed medicines. We found medicines continued to be administered safely and people received them as prescribed.

People felt safe and well cared for. Staff knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse. Risks were managed so that people were protected from avoidable harm and were not unnecessarily restricted.

Themes and trends in relation to accidents and incidents were reviewed and followed up with action where necessary.

The provider followed safe recruitment practice to check staff were of good character and suitable for their roles. Staffing was managed flexibly so that people received their care and support when they needed it.

People were supported by regular staff who were appropriately trained and supervised. Management observed how staff cared for people in their home to ensure their practice was safe and people received the support they needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The care plans evidenced people's involvement in the planning of their care and support. People's strengths and abilities were recorded and the importance of empowering people and encouraging independence was recognised.

People were treated equally, without discrimination. Staff encouraged them to live as full a life as possible, maintaining their independence where they could.

People were supported with their dietary and health needs. Staff took prompt action when people became unwell or were at risk from poor nutrition. They consulted other healthcare professionals to ensure that people received the additional support they needed.

Staff took steps to ensure people enjoyed meaningful activities and stayed connected to their local community.

There were regular checks on the quality of the care provided and the management team had good oversight of the service. The provider had effective links with external organisations and health professionals to make sure people received the care and support they needed.

People, their families and staff were encouraged to share their views and contribute to developing the service. Any concerns or complaints were acted on and the provider used learning from complaints to make improvements.

The provider used information from feedback and mistakes in a positive way to improve the care provided.

This inspection took place on 26 July and 2 August 2017 and was announced. We gave the provider 48 hours’ notice to ensure a representative from the management team would be available to speak with us. At this inspection we found the provider had met the requirements of the two warning notices we issued to them. The provider was also no longer breaching the regulation relating to the MCA.

Housing & Care 21 – Belsize Court is an extra care scheme. Belsize Court has a total of 63 flats for people aged 55 years and older. Thirty people using the service at the time of the inspection were receiving support from staff with their personal care, the majority of whom were living with dementia and some had other complex mental and physical health needs. Both the housing service and the care service were provided by Housing &Care 21.

The service did not have a registered manager in post. 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. At our previous inspections we found the service also did not have a registered manager. The manager who had been in post had begun the process to register, however, they resigned a few days before we announced our inspection due to personal reasons. The provider was recruiting for a new manager who would register with us.

People’s medicines were managed safely by staff as the provider had made improvements to medicines management. They contracted a new pharmacy who supplied medicines administration records printed with prescriber’s instructions. Previously staff recorded the prescriber’s instructions by hand and we found this led to recording errors which meant people did not always receive their medicines as prescribed. This improvement meant the risks of recording errors were reduced and medicines management was now safer.

The management team had reviewed their processes to assess whether people required authorisations of deprivations of liberty by the Court of Protection as part of keeping them safe. The provider had liaised with the local authority to request they make authorisations for people where required.

Risks to people were reduced as the provider now identified and assessed risks to people appropriately, putting management plans in place to mitigate these.

The provider implemented a robust action plan to assess, monitor and improve the service in relation to the concerns we identified at our previous inspection.

Before this inspection we received concerning information about medicines management practices. We carried out this inspection to look at these concerns as well as all other aspects of service provision. This inspection took place on 21 April 2017 and was announced.

Housing & Care 21 – Belsize Court is an extra care scheme. Belsize Court has a total of 63 flats for people aged 55 years and older. Thirty people using the service at the time of the inspection were receiving support from staff with their personal care, the majority of whom were living with advanced dementia and some had other complex mental and physical health needs. Both the housing service and the care service were provided by Housing &Care 21.

At our previous inspections the service did not have a registered manager. At this inspection the service still did not have a registered manager. The manager who was newly in post at our last inspection had not yet completed the process to register with us. 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.

Staff did not manage people’s medicines safely. Senior staff copied the prescribers’ instructions onto people’s medicines administrations records and we found errors in transcribing which meant people did not always receive their medicines as prescribed. Poor stock control by the provider meant people sometimes ran out of medicines and prompt action was not taken to obtain the required medicines.

Appropriate risk assessments and management plans were not always in place in relation to some risks to people, including risks relating to malnutrition, alcoholism, skin breakdown, behaviours that challenged and risks relating to catheter care.

Robust systems were not in place to review the quality of service provision and medicines audits failed to identify any of the issues we found during our inspection. In addition auditing systems had not identified the other issues we found during our inspection. Some information in care plans was inaccurate which meant people were at risk of receiving inappropriate care.

The management team did not appreciate their responsibilities to ensure applications were made to the Court of Protection to deprive people of their liberty lawfully as part of keeping them safe. Staff had a limited understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and what constitutes a deprivation of liberty.

People were positive about staff and told us they were kind. However we observed staff did not always respond appropriately to people living with dementia who were disorientated to time and place and agitated. In addition staff did not always ensure people’s privacy and dignity was maintained when providing personal care.

A staff training programme was in place although suitable training in relation to medicines management and catheter care in order to help staff understand people’s needs was lacking. Staff were supported through supervision and new staff followed a suitable induction. Further training was provided to staff such as diplomas in health and social care and leadership and management qualifications for the management team.

Staff were recruited through robust procedures to check their suitability. There were enough staff deployed to support people. Staff understood how to respond if they suspected people were being abused to keep them safe and the manager reported safeguarding concerns to the local authority appropriately.

The provider recently set up systems to monitor equipment such as hoists to make sure these were safe to use.

People received support in relation to food and drink and to access healthcare services such as GPs and dentists.

Staff knew people including their backgrounds and preferences and this information was recorded in care plans. Staff involved people in making choices about their care. The provider gathered information from the local authority and people to assess their needs before they began using the service.

Staff supported people to access activities they were interested in. There was a suitable complaints process in place. The provider had various ways of gathering feedback on the service from people and staff.

We found breaches of the regulations relating to safe care and treatment, good governance and deprivation of liberty. We issued warning notices in relation to the breaches concerning safe care and treatment and good governance. You can see what action we have asked the provider to take to address the breach relating to deprivation of liberty at the back of this report.

We undertook a focused inspection on the 25 October 2016 to check that they now met legal requirements. This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focussed inspections, by selecting the 'all reports' link for ‘Housing & Care 21- Belsize Court’ on our website at www.cqc.org.uk.

Housing & Care 21 – Belsize Court is an extra care scheme. Belsize Court has a total of 62 flats. 34 people using the service were receiving support from staff with their personal care. People using the service were aged 55 years and older, and had a mix of physical and learning disabilities. Both the housing service and the care service were provided by Housing and Care 21.

At our previous inspection the service did not have a registered manager. At this inspection they continued to not have a registered manager. A new manager was in post and they had begun their application to become registered. 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 staff had reviewed and updated risk assessments to ensure they identified the risks to people’s health and safety. Staff had developed plans to manage and mitigate those risks. This included in relation to moving and handling, personal care, skin integrity and prevention of falls.

The new manager provided leadership and management at the service. They were now using the provider’s systems to review key performance information and a full service audit had been undertaken to review the quality of service provision. Improvements had been made where the systems identified these were required.

The provider was now meeting the breaches of regulations identified at our previous inspection.

Housing and Care 21 – Belsize Court is an extra care scheme. Belsize Court has a total of 63 flats. Thirty-four people using the service were receiving support from staff with their personal care. People using the service were aged 55 years and older, and had a mix of physical and learning disabilities. Both the housing service and the care service were provided by Housing and Care 21.

At the time of our inspection the service did not have a registered manager in post. The provider was in the process of recruiting 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. The provider had recently undertaken a management restructure and in the days prior to our inspection, Belsize Court had been allocated a new operations manager. The operations manager was supporting the team leader to manage the service, whilst the recruitment of a registered manager was being undertaken.

The staff had not consistently identified, managed and mitigated the risks to people’s safety. We found that appropriate risk assessments and management plans were not in place in regards to the risk of people falling and risks associated with moving and handling and diabetes care.

Robust systems were not in place to review the quality of service provision. We found that systems were not in place to learn from previous incidents and focus on continuous service improvement. At the time of our inspection information from incidents and complaints was not reviewed to identify any trends or themes.

We found that some care records were not specific to people’s individual needs. Some contained incorrect or conflicting information which meant there were risks people might receive inappropriate care.

Staff were aware of people’s support needs. Staff liaised with people, their family and reviewed information from the local authority to identify people’s support needs, and how people wanted to be supported. People were involved in decisions about their care and were provided with a choice about how they were supported, as well as day to day decisions. Staff respected and maintained people’s privacy and dignity.

People were knowledgeable about the people they supported, including their support needs as well as their life history and what was important to them. People and staff had built positive caring relationships. There were opportunities for people to engage in activities they enjoyed as a group and individually. Events were also held at the service to celebrate key dates and religious festivals.

Staff supported people as required with their nutritional and health needs, and with their medicines. Staff encouraged and respected people’s independence but also provided them with the support they required at mealtimes and with meal preparation. Staff were available to liaise with healthcare professionals on people’s behalf if they needed support accessing their GP or other professionals involved in their care. For those who required it, staff administered people’s medicines and ensured they received their medicines as required. Improvements had been made to strengthen medicines management processes and ensure good practice was followed.

There were sufficient staff to attend to people’s needs. People told us that staff stayed the required time to meet their needs. If staff were running late this was communicated with people. In addition to the scheduled visits, there were staff available to respond to people’s needs as they occurred. For example, whilst people used the communal facilities and responding when people’s pendant alarms were activated.

Staff were supported to develop their knowledge and skills. Staff were required to complete training courses to ensure they stayed up to date with current good practice. Competency checks were in place to ensure staff applied their knowledge when supporting people.

Staff were well supported by their seniors and there was good teamwork. Staff felt able to express their views and opinions, and have open conversations amongst the team. They felt able to approach the management team if they had any concerns and felt supported to manage those concerns.

We found two breaches of the legal requirement requirements relating to safe care and treatment, and good governance. You can see what action we have asked the provider to take to address the breaches at the back of this report.