Archived: Short Term Breaks - April Cottage

There was 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager worked closely with the deputy manager and service manager.

On our previous inspection of the service on 17 and 18 June 2016, we asked the provider to take action to make improvements and ensure the registered manager had a clear understanding of their responsibilities in relation to completing mental capacity assessments.

This was a focused inspection to check whether the provider now met the legal requirements. We found the service had taken action to address our concerns. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Short Term Breaks - April Cottage on our website at www.cqc.org.uk

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.

Staff received adequate training and support to carry out their roles effectively. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager) to help them meet the needs of the people they cared for.

People had access to healthcare services and received on going healthcare support to enable them to maintain good health.

People were supported to maintain a balanced diet. There were food choices available and people were involved in preparation of meals. Where people wanted to lose weight, staff were at hand to support them through any weight loss programmes.

There was 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager worked closely with a director of operations.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework to assess people’s capacity to make certain decisions, at a certain time. However, the registered manager was not clear on their responsibilities to ensure the service completed their own mental capacity assessments if it was thought a person may lack the capacity to make certain decisions. Where people were thought to lack capacity, assessments in relation to their capacity assessments had not been completed in line with the principles of MCA.

Staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be restricted of their liberty for their safety.

People who used the service felt safe. Staff had a clear understanding of how to safeguard people and protect them from harm. Staff had a good understanding of their responsibilities to report any suspected abuse. The home had sufficient numbers of suitably qualified staff to meet people’s needs. People and staff were confident they could raise any concerns and these would be dealt with. The provider had systems in place to manage and support safe administration of medicines.

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.

People’s needs were assessed and care plans enabled staff to understand how to support people. Changes in people’s needs were identified through regular reviews. People's interests and preferences were discussed during assessments and these were used to plan their care. The service was flexible and responded positively to people’s requests.

People felt supported by competent staff. Staff benefitted from regular supervision (one to one meetings with their line manager) and yearly appraisals to reflect on their practice and develop their skills. Staff received training specific to people’s needs.

People and their relatives described the staff as good and providing very good care. People felt they were treated with kindness and their privacy and dignity were always respected. Staff had developed positive relationships with people.

The registered manager informed us of all notifiable incidents. The service had good quality assurances in place. The registered manager had a clear plan to develop and improve the service. Staff spoke positively about the management and direction they had from the registered manager.

The registered manager had a clear vision for the service which was shared throughout the staff team. This was embedded within staff practices and evidenced through people’s care plans. Staff felt supported by the registered manager and the provider.

Leadership within the service was open and transparent at all levels. The provider had systems to enable people and their relatives to provide feedback on the support they received. The feedback was acted upon when required.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we have required the provider to take at the end of this report.

We considered our inspection findings to answer 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?

This is a summary of what we found;

Is the service safe?

People were cared for safely. Risk assessments were in place and regularly reviewed. People's needs were assessed and reflected in the care plans.

There were arrangements in place to deal with foreseeable emergencies. There was emergency lighting and plans for managing the person's needs in the event of a power failure. Each person had an emergency evacuation plan for use in the event of a fire.

At our previous inspection we raised concerns that people were not always protected from unsafe or unsuitable equipment due to the poor state of repair of the minibus. The provider had since carried out a complete refurbishment on the interior of the bus and a risk assessment was in place to ensure that people were able to get on and off the mini bus safely.

Systems were in place to make sure that managers and care workers learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to continually improve.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made the manager was able to describe the circumstances when an application should be made.

Is the service effective?

The service was effective. People had individual care plans which set out their care needs. People's needs were assessed and people told us they were involved in their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Care workers told us they felt supported in their role. One care worker told us "I love working here' and 'I am very supported". Most care workers had achieved a National Vocational Qualification (NVQ) in care. Care Workers received regular supervision which provided them with the opportunity to discuss their areas of responsibility and identify training needs. This meant care workers were appropriately trained and supported to care for people staying at April Cottage.

Is the service caring?

April cottage provided a caring service. People we spoke with were complementary about their stay. One person told us, 'I like it here'. Another person told us 'I have fun here'. The atmosphere in the home was pleasant and we observed interactions between care workers and people that were caring, warm, relaxed and friendly.

People were supported to express their personal relationships and sexuality in a safe and appropriate way. Care plans showed that people, their representatives and care workers had been involved in identifying how this could be managed safely and sensitively without being intrusive.

Is the service responsive?

The service was responsive. People benefitted from meaningful activities and engagement with staff. During their stay people were offered a wide range of activities which were planned around their likes and preferences. One person told us 'there is plenty to do'. We saw in one person's activity plan that they enjoyed knitting. Their activity plan reflected this and we saw that they were supported to spend time knitting whilst staying at April cottage. This showed that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The provider took account of any complaints, comments, accidents and incidents to improve the service. We saw evidence that these were discussed in team meetings. This meant that actions could be discussed with care workers to prevent further incidents of a similar nature occurring.

Is the service well-led?

The service was well led. The home worked with other agencies and services to make sure people received their care in a joined up way.

Care workers spoke positively about the service they provided for people, the manager and each other. Care workers felt supported. One care worker told us "I am most definitely supported. The manager is amazing and we all support each other.' Another said "It's a good team. I am supported by the team, we can talk through everything". Care workers had regular supervisions and told us they felt able to raise any concerns with the manager at any time. This meant that care workers felt confident that they would be listened to and that any concerns they had would be taken seriously.

During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the service was monitored on a consistent basis to ensure that people experienced safe and appropriate support, care and treatment.

People and their relatives told us that April cottage was a safe place to stay. People's needs were assessed when they started to use the service and these were regularly updated. A relative told us "we always talk about any changes'. Care records were person centred and information in these records had been used to form a detailed and individualised care plan. People were cared for by staff who were supported to deliver care and treatment safely.

We saw that the step on the minibus was broken. Feedback from people indicated that the step on the minibus had been broken for some time. Some comments noted on the forms included "find it difficult to get in and out as step broken". This meant that people were not always protected from unsafe or unsuitable equipment.

We saw that there was a clear procedure for recording incidents and accidents and learning from these took place. We did not see any audits that had been undertaken since our last visit. This meant there was not a system in place to monitor the quality of the service.

We saw that people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. People told us if they had any concerns they would report them to the manager or senior person on duty.

Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The Provider had effective systems in place to monitor and assess the quality of the service.