The inspection took place on 10 December 2018 and was announced. We last inspected the service on 2 and 6 October 2017. We found the provider had breached the regulations relating to safe care and treatment, person-centred care, need for consent and good governance. We rated the home as requires improvement.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, effective, caring, responsive and well-led, to at least good.
During this inspection we noted improvements had been made and the provider was now meeting the requirements of the regulations. For example, improvements had been made to medicines management and risk assessments contained more information than previously. However, we noted risk assessments would benefit from more detailed information about the measures required to mitigate risks. The provider had implemented systems to support staff when making Mental Capacity Act (MCA) assessments. We have made a recommendation about this as, although staff followed the correct process, the decisions considered were not always relevant. Improvements had also been made to the quality assurance processes.
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 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 and support service.
Not everyone using Haddington Vale 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.
The service had 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.
People said they were very well cared for and told us the staff were kind, considerate and caring. Care records provided staff with a summary of people’s preferences.
People and staff told us Haddington Vale was a safe place to live.
Staff had a good understanding of both safeguarding and the provider’s whistle blowing procedure. They told us they hadn't needed to use the procedure but wouldn't hesitate to do so if required.
Staffing levels were sufficient to meet people’s needs. People told us staff were very reliable and responded to their needs well.
There were robust recruitment procedures to ensure new staff were suitable to work at the service.
Incidents and accidents had been logged, with details recorded of the action taken to keep people safe. These were monitored to identify any trends.
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.
Current care plan audits were infrequent which presented as risk issues would not be addressed quickly.
Staff were well supported and received the training they needed. Records confirmed supervisions, appraisals and training were up to date. The provider made resources available for the training and development of staff.
People were supported to meet their nutritional needs as required. Where necessary, staff supported people to attend healthcare appointments.
The service user guide provided details of important information, such as the availability of advocacy services and the provider’s complaint procedure. This was made available to all people when they moved into the service.
Some people had specific healthcare conditions, such as diabetes. The associated care plans lacked the depth of information to clearly describe how staff should support people to manage these conditions. People told us they had been involved in developing their care plans.
Staff supported people to access activities to help avoid social isolation. This included supporting people to access their local community and arranging events within the service.
People had the opportunity to discuss their end of life care wishes. Where people had specific requests, these were included in their care plans.
Although people gave positive feedback, they knew how to raise concerns if needed.
The provider consulted and engaged with people and staff to gather their views about the service.
The provider was submitting statutory notifications for significant evets as required.
Although governance arrangements were mostly effective, care plan audits were infrequent. We noted there was positive collaboration between the provider, commissioners and the housing provider.