Archived: Childwick House

Childwick House consists of 24 self-contained flats, three of which have two bedrooms for double occupancy. The service is situated centrally within the town of Newmarket and within close vicinity of the local amenities. The service provides support to people to live in their accommodation, with their own tenancy agreements. The aim of the service is to provide people with support they need to live as independently as possible. The people who used the service received individual bespoke support hours depending on their assessed needs.

The 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. 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 living at Childwick House received the regulated activity; on the day of our visit 15 people were receiving a personal care service.

At the last inspection in October 2016, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We were concerned because the provider had failed to assess all risks to health and safety and failed to manage medicines. We also had concerns that the provider was failing to ensure that there were sufficient numbers of suitably qualified, competent, skilled and experienced staff. We asked the provider to take steps to improve and complete an action plan to show what they would do and by when to improve. At that inspection we rated the service Requires Improvement overall and in four of the key questions we ask of each service. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Childwick House on our website at www.cqc.org.uk

At this inspection in March and April 2018 we found improvements had been made in some of these areas however we still had concerns about staffing levels and also we had additional concerns. As a result the service has been rated Requires Improvement again. We have also made a recommendation that the provider considers good practice guidance to ensure that the service understand and meets the requirements set out in the Mental Capacity Act 2005.

There was a registered manager in post at the time of the inspection. 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 service was not always acting in accordance with the Mental Capacity Act 2005. People’s rights were therefore not always being promoted. Staff did not always work within these principals when supporting people who lacked the mental capacity to make decisions.

There was a quality assurance audit in place however the system was not always effective because issues identified at the inspection had not been recognised during the monitoring and auditing process.

Medicines were managed in a safe way and support was offered by staff when needed. Risks to people and staff had been assessed. People felt safe and when risks to people were identified action was taken to reduce these risks.

People were protected from the risk of infection by staff that complied with their infection prevention policy.

People were happy with the support they received to eat and drink, and were supported to maintain good health and had access to healthcare when required.

Staff provided a service which was caring, respectful and promoted people's privacy and dignity. Staff encouraged people to be as independent as safely possible.

The service provides extra care housing for people living in each of the 24 flats within the same secure building. At the time of our inspection 23 people were resident. Staff are onsite 24 hours a day and people who use the service are able to summon help outside of their normal contracted care visits by using a call bell system. Although aspects of the service operate in a very similar way to a registered care home, the Care Quality Commission only regulate the provision of personal care in services such as this.

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.

Staff had received training in safeguarding people from abuse. Staff mostly understood their responsibilities in this area but we found that some matters had not been appropriately referred to the local authority for investigation or notified to us.

The service assessed risks people faced but information was not comprehensive and some risks had not been assessed. There was insufficient guidance for staff to follow in order to reduce the likelihood of some risks.

Staffing levels were assessed but the service did not always operate in line with this. Staffing was recognised as a concern and action had been taken to try to ensure consistent staffing as much as possible.

Medicines were not always administered safely and errors were identified which placed people at risk of harm. Records related to medicines were not clear and the provider addressed this issue by the time of our second inspection visit.

Training and support was provided for staff to help them carry out their roles and increase their knowledge. There was an induction process in place but records of people’s progress were not all complete.

People gave their consent before care and treatment was provided and staff had received training in the Mental Capacity Act (MCA) 2005. The MCA ensures that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process.

People were supported with their eating and drinking and staff helped to ensure that people had access to the food and drink they might need after staff had left for their next call. Staff also supported people with their day to day health needs and worked in partnership with other healthcare professionals. Information in care plans relating to health conditions did not give staff clear guidance about people’s specific needs.

Staff were caring and people were treated respectfully and their dignity was maintained. Relationships between the staff and those they were caring for and supporting were very good and agency staff were used as consistently as possible to try to minimise concerns people had regarding staff not being familiar with their needs. There was a strong sense of community amongst the people who used the service and this was important to them.

People were involved in planning and reviewing their own care and were encouraged to provide feedback about the service. There was a commitment to preserving people’s own skills and maintaining their independence.

Although the service sought to provide individualised care which met people’s changing needs this was not always possible due to the staffing levels in place. As people’s needs reached a particular threshold they were supported to move on to other accommodation.

A formal complaints procedure was in place but none had been received. Informal complaints were dealt with appropriately.

Staff understood their roles and were supported by the management team. There was an open culture which staff and people using the service valued. Staff shortages had meant that management time had been reduced on occasions and the registered manager had not had clear oversight of all the issues facing the service.

Comprehensive quality assurance systems were in place to monitor the delivery of the service but some of these were not effective.

We found breaches of regulations during this inspection. You can see what action we have told the provider to take at the back of this report.

We looked at four people's care records. The records provided information for staff on how to meet people's individual health and care needs. The records showed that people's needs were assessed and care and treatment was planned in line with their individual care plan. We saw evidence in the care records that people received safe and coordinated care, treatment and support where more than one provider was involved.

We saw that staffing levels were sufficient to meet people's care needs and staff interacted with people in a caring, respectful and professional manner.

The provider had systems and procedures in place to monitor and assess the quality of the service provided.

The registered managers identified in this report are no longer the registered managers of the service. We were advised that the provider had submitted an application to remove them from our records.