Archived: The Huntercombe Neurodisability Centre - Crewe

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.

During the inspection we spoke with the registered manager, a unit manager, the clinical psychologist, two occupational therapists and five staff members. We also spoke with five of the people who lived in the home and three of their relatives.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people living in the centre and their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The staff were able to describe various forms which abuse might take and each member of the care staff we spoke with showed an understanding of their responsibilities when caring for vulnerable adults. We asked the registered manager about training in protecting vulnerable adults and the Mental Capacity Act. They showed us records that demonstrated that currently 61% staff had received updated Safeguarding Adults training. We also saw that 57% staff had received training in the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS). The registered manager told us that they were aware that not everyone had completed an update and were prioritising staff to complete the training as soon as possible.

We looked at the safeguarding policy. This was available in the office. All the staff we spoke to were aware of the policies and how to access them. The registered manager was able to demonstrate a good understanding of the reporting systems for the local authority and the Care Quality Commission in relation to safeguarding people. They described to us the processes that were currently being carried out to ensure that Deprivation of Liberty Safeguards referrals were made to the local authority for people who lived in the centre that the home's clinical psychologist had assessed required it to protect them from harm.

Is the service effective?

During our inspection we looked at a variety of records including care plans, risk assessments and communication records. We looked in detail at the care files of five people. All of them had been monitored monthly and updated at regular intervals. We saw that changes had been made to the daily records that were held in people's rooms. We saw that care was being monitored and recorded appropriately. Staff we spoke to told us that the new system was much easier and clearer to use.

The registered manager and the unit manager told us that all the daily records on each unit were checked by the nurse in charge during and at the end of each shift to ensure that staff were recording the care being given.

Is the service caring?

We spoke with five people who used the service and three relatives. People told us they were much happier with the changes that the registered manager had introduced. One person told us; "There has been a vast improvement since the manager came. We get better care now. The dark days are over." Another person told us; "The staff treat me with respect. I don't want to be patronised and the staff are consistent now and they know how I want to be supported."

We spoke with five members of staff who were knowledgeable about people's individual needs and how they were being met. We saw that staff had affectionate, warm relationships with people and they knew how to communicate with people to care for them in the way they wanted to be cared for. One person told us; "They promote my independence now. They are listening now and involve me in my care rather than care for me."

Is the service responsive?

We found people who lived in the centre were encouraged to make choices in all aspects of their care, treatment and support. During our inspection we observed that staff explained to people the type of care they were giving and the reason for it. For example, we observed two care staff explaining to the person whilst they were being supported to move using equipment. This was done in a way so that the person was able to understand the procedure.

We saw that people's care needs were supported by a multidisciplinary team. This included physiotherapists, occupational therapists and a clinical psychologist. We saw that regular multi-disciplinary team meetings were held where people's care plans were reviewed and that these were documented within people's care records, with changes to care plans made as required. During our inspection we saw the clinical psychologist meeting with people and we saw people in the gym working with the physiotherapist. People who lived in the centre told us that they valued this support.

Is the service well led?

The registered manager had been working at the centre for six months and they told us that they had made some changes to how the centre was assessed and monitored. They showed us the care plan audits that they had carried out. Every care file had been audited three times by the registered manager and significant changes and improvements had been made.

We saw that a number of staff meetings had been held since the registered manager had been in post and further meetings were advertised around the centre. Staff we spoke to told us that communication had significantly improved and that they were kept informed now and knew what was expected of them. All the staff we spoke with expressed confidence in the registered manager and what had already been achieved. Comments we received included; "The manager says what she is going to do and then she does it. We trust her" and "This place is now what I've always wanted it to be; good, and we provide good care."

We looked at the recruitment procedures in place at the centre and saw that staff were recruited in a safe and effective manner.

We checked that there were sufficient numbers of staff employed at the centre. We saw that there were planned staff rosters in place to ensure that staff were available and that any gaps in the rosters were identified. We saw that there were arrangements in place to ensure that sufficient staff were available to meet people's needs.

We used a number of different methods to help us understand the experiences of people who lived at the centre. This was because some of the people using the service had complex needs. We spoke to family members and looked at seven care records.

We looked at a selection of care records. These contained information regarding the needs and wishes of individuals and the care that they had agreed with the service.

We found that systems were in place to monitor the quality of the service provided. We saw evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.

We spoke with five members of staff who all told us that they enjoyed working at the home and that they felt well supported in their roles.

We looked at seven care records. We found that there were gaps and inconsistencies in some the records we viewed.

We found improvements had been made. Processes were in place to ensure people living at the centre gave consent to the care and treatment they received or where they lacked capacity to give consent decisions were made in their best interest. The centre had also introduced training programmes including a thorough induction for newly recruited staff. We saw the centre had an audit programme to monitor and improve the service it provided covering areas such as medication and care planning. We were also assured that processes were now in place to protect people from the risks of the unsafe use of medicines.

We spoke with two family members who regularly visit the centre. Both said they considered care to be good. Comments included: 'they provide care to meet his needs' and 'communication is very good, as they always keep me informed of what's going on'.

We spoke with four people who lived at the centre who said they were happy with the care and support provided. Most people told us that they were involved in the planning of their care. Comments included: "its very good, top marks' and 'I can talk to anyone'.

Overall we found the centre was now compliant in all previous areas of concern. This progress needs to be sustained alongside the further improvements planned by the provider.

However, we found improvements had not been made in a number of areas which meant patients continued to experience poor care that had a negative impact on their health, safety and welfare. Patient's care and treatment needs were not being met due to a lack of appropriate specialist staff and equipment. Where people did not have the capacity to consent, the provider had not always acted in accordance with legal requirements. Safeguarding concerns had not always been appropriately reported and acted on and patients were not protected against the risks associated with the unsafe use and management of medicines. Staff were not appropriately trained to meet patient's needs and effective systems were not in place to monitor the quality of service.