Background to this inspection
Updated
8 February 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 2 November 2016 and was unannounced.
The inspection team consisted of two inspectors, a member of the CQC medicines team and an expert-by-experience and their supporter. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert had experience of services for people with learning disabilities and had a learning disability themselves.
Before we carried out our inspection we reviewed the information we held on the service. This included looking at previous reports and the action plan we received following the last comprehensive inspection. We reviewed the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at the statutory notifications that had been sent to us since the last inspection. A notification is information about important events which the service is required to send us.
We spoke with six people who used the service and observed care and support being provided for those who were not able to communicate with us verbally. We spoke with seven care staff, an agency staff member, the registered manager and the area operations manager. We also spoke with three relatives.
We reviewed eight care plans, nine medication records, six staff recruitment files and staffing rotas covering eight weeks. We also reviewed quality monitoring records and records relating to the quality and safety of the service.
Updated
8 February 2017
The inspection took place on 2 November 2016 and was unannounced.
Lombardy Park is a purpose built residential service providing support and accommodation to 15 adults with learning disabilities and a supported living service to others living in the same complex.
The service had a registered manager in place. 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.
When we last inspected this service on 31 March 2015 we found that staffing levels were not sufficient to ensure people were safe and were able to live their lives the way they chose. We gave the provider a requirement notice and they submitted an action plan documenting how they would improve. At this inspection we found the situation had improved, although further improvements are still needed in some parts of the service.
We found that staffing levels enabled most people to be supported to live their lives fully and safely but there was still a negative impact for some, especially those who required higher staffing levels to access the local community. The service has recently split into two different kinds of service, a registered service providing accommodation and care and a supported living service where people have the status of tenants. This has brought about a significant change in the way staffing was managed and was designed to be beneficial to the people who used the service.
Recruitment procedures were designed to ensure that staff were suitable for this type of work and checks were carried out before people started work to make sure they were safe to work in this setting. Some staff records showed that checks had not been rigorous in all cases which posed a possible risk.
Staff were trained in safeguarding people from abuse and systems were in place to protect people from abuse. Staff understood their responsibilities to report any safeguarding concerns they may have and were confident they had the skills to do this. The service made appropriate safeguarding referrals and worked with the local authority to undertake investigations into safeguarding concerns. Systems designed to protect people from financial abuse were not always adhered to.
Risks to people and staff were assessed, clearly documented and action taken to minimise these risks. We were not told about a possible infection control risk during our inspection and there was a lack of clear strategy to deal with this risk.
Medicines management was mostly good, however some documentation could have been clearer to ensure less experienced staff gave people their medicines consistently.
Training was provided for staff to help them carry out their roles and increase their knowledge of the healthcare conditions of the people they were supporting and caring for. Staff were supported by the managers through supervision and appraisal systems. New staff were able to shadow more experienced staff and a robust induction was provided
People gave their consent before care and treatment was provided. Staff had been provided with training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s capacity to give consent had been assessed and decisions had been taken in line with their best interests. DoLS applications had been appropriately submitted to the local authority.
People were well supported with their eating and drinking needs and people were involved in shopping and cooking. Staff helped people to maintain good health by supporting them with their day to day physical and mental healthcare needs. Support for specific health conditions such as epilepsy and diabetes was good and staff demonstrated good knowledge of these conditions.
Staff were caring and treated people respectfully making sure their dignity was maintained. Staff enjoyed the relationships they had built with the people they were supporting and caring for and interactions between staff and those they were supporting were kind, friendly and patient.
People, and their relatives, were involved in planning and reviewing their care and were encouraged to provide feedback on the service. Care was individualised and subject to on-going review and care plans identified people’s particular preferences and choices. People were supported to follow their own interests and hobbies.
There was a complaints procedure in place but no formal complaints had been received. Informal issues were dealt with promptly and well. People who used the service and their relatives and legal representatives had been consulted and supported to understand the implications of the recent changes at the service.
Staff understood their roles and were well supported by the management of the service. The service had an open culture and people felt comfortable giving feedback and helping to direct the way the service was run. Staff were positive about their work and feedback from staff was that the service was improving.
Quality assurance systems were in place and audits were carried out regularly to monitor the safety and quality of the service.