26 January 2017
During a routine inspection
The managing director of Aldernat Care was the registered manager and was based at the central offices along with other administrative personnel. 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 told us that they felt safe and had a good relationship with the staff who supported them. The service had been commissioned to provide staff support with a care package of allocated hours to meet individual’s needs. While we saw evidence that some people were receiving their full allocation of commissioned hours it was not always possible to ascertain what individual staff support was being provided and if the deployment of staff reflected all of the people’s needs.
The systems to manage risk did not always work effectively and while actions were taken when things went wrong, the service needs to improve their assessment of risk to mitigate the risks to people’s health, welfare and safety.
Medication was appropriately stored. However it was not consistently well managed and we have asked the manager to seek advice from the supplying pharmacy on supporting people who need to take their medicines with them when they go into the community.
Staff were knowledgeable about the signs of abuse, and the actions that they would take should they have a concern. We saw that staff received training on a range of areas including first aid, health and safety and autism. Staff also received training on how to defuse situations to reduce the need for restraint. However, there were gaps in training, in areas such as mental health but the provider assured us that they had identified this and had a plan to address this.
The provider had policies in place with regard to the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) 2005. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. Care staff had a good understanding of the importance of obtaining consent and protecting people’s rights.
We observed staff to be kind and caring and people who lived in the service looked at ease with staff. They were not all able to talk to us about the support they received so we spoke with their relatives who were largely positive about the service and the commitment of staff. They told us that staff kept them updated and communicated with them.
People’s independence was not always consistently promoted. We found examples of good practice in some projects but not in others. People would benefit from a greater emphasis on goal setting and ascertaining peoples aspirations. People’s access to the community varied and this could be developed further in some of the projects.
There were procedures in place to manage and respond to complaints.
There was a lack of consistency across the service. There were elements of good practice but also areas where improvements were needed.
The provider had some oversight and had already identified some of the issues we found. There was some evidence of reflective practice and we saw that some changes were planned to improve the quality of the service.
During the inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we told the provider to take at the back of the full version of the report