Background to this inspection
Updated
15 June 2016
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 over two days on the 14 and 16 March 2016 and was unannounced. The inspection was carried out by an adult social care inspector, expert by experience and specialist advisor on the first day and an adult social care inspector and inspection manager on the second day. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Specialist Advisors are senior clinicians and professionals, who bring specialist knowledge and expertise to the inspection. Both the ex by ex and specialist advisor had experience of caring for people with either learning disabilities or neurological conditions.
Before the inspection we reviewed the information the Care Quality Commission already held about the home. This included information from the provider, such as statutory notifications. Statutory notifications include important events and occurrences which the provider is required to send to us by law. We contacted the local authority contracts and quality assurance team prior to the inspection and they shared their current knowledge about the home. We also read the latest Healthwatch report available.
During the inspection we spoke with 13 of the people who lived at the home, together with two of their visiting relatives. We talked with 14 members of staff including five members of the care staff team, four nurses, the activities coordinator, a housekeeper, the maintenance person, the deputy and the home manager.
We reviewed four people’s care records and inspected other documentation related to the day to day management of the service. These records included four staff files, staff rotas, quality audits, meeting minutes, training records, supervision records and maintenance records. We toured the building, including bathrooms, store rooms and with permission spoke with some people in their bedrooms. Throughout the inspection we made observations of care and support provided to people in the communal areas and observed how people were supported over lunchtime.
Updated
15 June 2016
The inspection took place on the 14 and 16 March 2016 and it was unannounced. At the last inspection on 19 June 2014 the registered provider was compliant with the regulations that we assessed.
The Huntercombe Neurodisability Centre is located in central Crewe. The centre provides care and treatment for people with long term neurological conditions and people with neurological conditions acquired through illness or injury. There is also a one bedded flat for people preparing to leave. The home is registered to provide a service for up to 40 people. On the day of our inspection there were 30 people living in the home.
At the time of the inspection the home did not 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. However a manager was in place and had made an application to become registered with CQC, which was near completion.
We identified two breaches of the relevant legislation in respect of nutritional needs and good governance. You can see what action we told the provider to take at the back of the full version of the report.
We found that there had been a period a time when the home had depended upon agency staff to ensure that there were sufficient staff and this meant that there was less consistency of care. There had been a recent focus on the recruitment of new staff and the manager told us that the home was now fully staffed. However during the inspection we found that staffing on the first day had been affected by staff sickness which impacted on the care provision. There has been some re-organisation within the home and a new allocation system implemented to support staff and enable them to meet people's care needs in a timely manner.
People received their medication in a way that protected them from harm. The staff were working with people's GPs, to ensure that appropriate protocols were in place for medication which was taken "as and when required". People had good support from health professionals based within the home such as psychology and speech therapy. The manager was also recruiting for an occupational therapist.
We found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to protect people from abuse. However we found that not all staff knew where they could report safeguarding concerns to outside of their organisation. Risk assessments were completed to guide staff in how to minimise risks and potential harm.
People lived in a safe environment and staff ensured equipment used within the service was regularly checked and maintained. However we found that not all areas of the home were visibly clean and some areas appeared cluttered and untidy.
Arrangements for eating and drinking did not always take account of individual needs and requirements. We found that the dining experience was not a particular cheerful or sociable experience. People's views on the quality of the food were mixed. The manager had already acted upon feedback received about the food to make improvements.
Staff had completed a thorough induction before commencing their employment at the home and staff received on-going training. There had been a recent focus on staff training needs.
Staff had received training in legislation such as the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They were aware of the need to gain consent when delivering care and support and what to do if people lacked capacity to agree to care or treatment. Where a person was being restricted or deprived of their liberty, applications had been made to the supervisory body under the Deprivation of Liberty Safeguards.
People told us that staff were kind and treated them in a caring manner. However, we observed that staff did not always maintain people's privacy and dignity. Confidentiality was not always maintained with regards to the storage of records and where people's personal information was on display.
Care records were personalised and up to date, they reflected the support that people needed so that staff could understand how to care for the person appropriately. We saw that staff responded to people’s changing needs and sought involvement from outside health professionals as required.
We found that in some care records and daily charts there were gaps in the information recorded and they had not always been completed at the time that the care had been provided.
People had access to activities both within the home and local community. People were encouraged to maintain their independence.
People and staff told us that the home was well led and that the management team were approachable and supportive. We found that the manager had taken steps to improve the quality of the care provided. We saw that regular team meetings and supervision with staff were held. People's feedback was sought and there had been four resident/relative meetings since the manager had come into post.
Quality assurance systems were in place and audits were carried out to highlight areas where improvements were needed. We asked for information about any quality assurance or monitoring visits carried out by the provider, but there were none available and we were unable to evidence that the organisation provided support to the management team to monitor the quality of the service provision.