Archived: Spencer House

Spencer House is a residential care home providing accommodation and personal care to 19 people aged 65 and over at the time of the inspection. The service can support up to 25 people.

People’s experience of using this service:

People were treated with kindness, respect and compassion. We saw staff listening to people, answering questions and taking an interest in what people were saying.

People were supported to express their views and be actively involved in making decisions about their care and support. People's privacy, dignity and independence were respected and promoted. One person said, “I cannot fault it here, I am safe, happy and content living here.”

People were protected from abuse. Staff received regular safeguarding training, knew how to identify potential signs of abuse and knew how to report concerns. Risks to people and the environment were assessed and minimised. Risks associated with people’s care had been identified and appropriate risk assessments were in place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the provider policies and systems in the service supported this practice.

People’s needs were met by the adaptation, design and decoration of the service.

People had good relationships with staff, who were knowledgeable of their support needs, as well as likes, dislikes and interests. Staff were responsive to changes in people's health needs. If needed, they sought advice from relevant professionals.

There were enough staff to keep people safe and meet their needs.

The registered manager recruited staff with relevant experience and the right attitude to work with people. New staff were given an induction and all staff received on-going training.

People’s needs were assessed, and their care was delivered in line with current legislation.

People felt included in planning their care. The care plans used were consistently reviewed and updated.

Care planning informed staff what people could do independently and what staff needed to do to support people.

People could involve relatives and others who were important to them when they chose the care they wanted.

People told us they were listened to by the management of the service.

Staff supported people to maintain a balanced diet and monitor their nutritional health. People had access to GP’s and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

Medicines were stored and managed safely. There were policies and procedures in place for the safe administration of medicines. People received their medicines when they needed them from staff who had been trained and competency checked.

People were protected by the prevention and control of infection.

People felt comfortable raising any complaints with staff and the registered manager.

People were asked for feedback about the service they received.

People said the registered manager was approachable and supportive.

Accidents and incidents were reported by staff in line with the provider’s policy, and the registered manager took steps to ensure that lessons were learned when things went wrong.

The provider and registered manager made sure they monitored the service in various ways to ensure they continued to provide a good quality service that maintained people’s safety.

The provider, registered manager and staff were working with a clear vision for the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

This service was rated, ‘Requires Improvement’ at the last inspection (published on 25 July 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At this inspection, we found the service met the characteristics of ‘Good’ in all key questions.

Why we inspected:

This was a comprehensive inspection scheduled based on the previous rating.

Follow up:

We will continue to monitor the service.

Spencer House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under on contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Spencer House accommodates up to 25 people in one adapted building. At the time of the inspection 22 people were living at the service.

We last inspected Spencer House in March 2017, when two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations were identified. We issued requirement notices relating to safe care and treatment and good governance. The provider had not maintained the building to the required standards and issues relating to unsafe management of medicines. The provider had failed to monitor and improve the quality of the service and maintain accurate and complete records.

At our last inspection, the service was rated ‘Requires Improvement’. We asked the provider to complete an action plan to show how they would meet the regulatory requirements. At this inspection improvements had been made, however, there was a continued breach of Regulation 17, Good Governance. This is therefore the second consecutive time the service has been rated ‘Requires Improvement’.

The registered manager had left their post in May 2018. An acting manager had joined the service at the beginning of June 2018 and had started their registration with Care Quality Commission (CQC). A registered manager is a person who is registered with the CQC to manager the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.

Following the last inspection in March 2017, the provider employed a registered manager. They had entrusted the registered manager with maintaining, monitoring and improving the quality of the service. The provider was present at the service regularly but had not maintained oversight of the service. The provider had not identified the shortfalls found at this inspection.

Checks and audits had not been completed on the quality of the service being provided. Accidents and incidents had not been analysed to identify any patterns or trends to learn lessons and stop them happening again.

Potential risks to people’s health and welfare such as diabetes, had not been consistently assessed and staff did not have detailed guidance to mitigate the risks. However, staff knew how to support people to reduce risks and described how they supported people living with diabetes. Each person had a care plan that contained details about their choices and preferences, but some information contained in the care plans was contradictory. However, people told us that staff supported them in the way they preferred.

The acting manager had completed an audit on all aspects of the service the week before this inspection and had identified all the shortfalls the inspection found. The acting manager had put an action plan in place and had started to rectify the shortfalls.

The acting manager understood their responsibilities to keep people safe. Staff explained how they would raise any concerns they had and were confident that the acting manager would act appropriately.

There were sufficient staff on duty, who had been recruited safely. Staff received training appropriate to their role, new staff completed an induction programme. Staff told us they felt supported by the provider and had regular supervisions to discuss their training and development.

People received their medicines safely and on time. Staff monitored people’s health and reported any changes to the GP and other healthcare professionals. Staff followed the guidance given to keep people as healthy as possible. People were encouraged and supported to live healthier lives, people took part in chair exercises and went out for walks. People were supported to be as independent as possible. People had a choice of meals and were encouraged to eat a balanced diet.

Before moving into Spencer House, people were assessed to ensure staff would be able to meet their needs. People’s needs were assessed using recognised tools in line with current guidelines. People’s end of life wishes were recorded when known. Staff liaised with the district nurse and GP to keep people comfortable and pain free at the end of their lives.

People were encouraged to plan their care and express their views. 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. Decisions were not always recorded, this is an area for improvement.

The provider had a complaints policy, this was displayed in the reception of the service. People told us that they knew how to complain. However, the policy was not available in other formats such as large print or easy read. This was an area for improvement.

People had a variety of activities to take part in, activities included gardening, quizzes and flower arranging. People’s dignity and privacy was respected, staff spoke with people in a kind and compassionate way. People had developed caring relationships with staff and were relaxed in their company.

The provider and acting manager had a vision that the people and the community would be more involved in the way the service developed. There was an open culture within the service, people and relatives knew the provider and that they could speak to them whenever they needed.

People and staff attended regular meetings and made suggestions for improving the service. The provider had listened and made improvements including updating a bathroom with a walk-in shower.

The provider intended to take part in local forums to keep their skills up to date, they had not been attending previously. The service had worked with the local safeguarding authority and local commissioning groups to ensure people received joined up care.

Since the last inspection, the provider had completed further adaptations and improvements to the building to meet people’s needs. The service was clean and odour free. The provider completed checks and audits on the building and equipment that people used to ensure it was safe.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The provider had submitted notifications to CQC in an appropriate and timely manner in line with guidance.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall. The service did not have a website.

At this inspection a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. You can see what action we have asked the provider to take at the end of the report.

Spencer House provides care for up to 25 older people some of whom maybe living with dementia. At the time of the inspection 22 people were living at the service. Spencer house offers residential accommodation over three floors, has two dining rooms and two lounges, there is a stair lift to access the first and second floors. Spencer House is situated in the village of Birchington, there is a secure garden at the rear of the premises.

The service does not have 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 requirements in the Health and Social Care Act and associated Regulations about how the service is run. There was a manager in post who was not present on the day of the inspection. During the inspection we were supported by the provider.

People told us that they felt safe living at the service, however, the provider had not consistently completed checks on the environment to ensure people remained safe. The environmental risk assessments were not up to date. Water temperatures had not been checked to ensure that they were at a safe level to reduce the risk of scalding. There were no personal emergency evacuation plans (PEEP) for each person, to inform staff about how to evacuate people safely. Staff and people had not taken part in a fire drill, there was a risk that they would not know how to leave the building safely.

People told us that they received their medicines when they needed them. However, medicines were not consistently recorded and managed safely. There were audits and quality assurance systems in place, but these had not been completed consistently. Audits had identified shortfalls, but, the provider had not taken action to rectify the shortfalls. Feedback from people, staff and relatives had not been analysed and used to improve the quality of the service.

The provider had not maintained complete and accurate records; safety certificates were not available at the time of the inspection. After the inspection copies of the safety certificates were provided.

People were protected from the risks of abuse and avoidable harm. Risks to people were assessed and there was guidance for staff on how to reduce risks. Staff were confident that any concerns raised would be investigated to ensure people were safe. They knew about the whistle blowing policy and, if required, to report concerns to agencies outside of the service. There were systems in place to record and receipt any monies spent which were regularly audited.

Accidents and incidents had been analysed to identify trends and patterns. Action plans and risk assessments had been put in place to reduce the risk of them happening again.

Recruitment processes were followed to make sure staff employed were of good character. There were sufficient staff on duty, and contingency plans to cover a shortage of staff in an emergency.

People received effective care from staff who had the knowledge and skills to carry out their roles. The provider had identified that some training needed to be refreshed and training had been booked to address the shortfalls. . Staff were knowledgeable, able to tell us and we observed how they put their training into practice.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The provider understood their responsibilities in relation to DoLS. The requirements of the Mental Capacity Act 2005 (MCA) had been met. Staff understood the importance of giving people choices and gaining consent.

People were offered a choice of healthy meals which people told us they enjoyed. Staff monitored people’s weight to make sure they remained as healthy as possible. People were referred to specialist health professionals when needed and staff followed the guidance given.

People told us they were treated with kindness and their privacy and dignity were respected. Staff knew people well and supported them to be as independent as possible. People’s records were stored securely to maintain confidentiality.

People were involved in planning their care and support. People received care and support that was individual to them. People told us that there were not enough activities for them to enjoy, the provider had employed an activities co-ordinator to address this shortfall.

People knew how to complain and raise concerns, they were confident they would be listened to. Complaints received had been analysed and any improvements identified had been made.

The management team worked with staff each day and encouraged an open and transparent culture. Notifications to CQC had been submitted in line with guidance.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.