Archived: Cordwainers

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-

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that medicines were safely administered to people using the service, and appropriate records were kept to show this.

Appropriate Deprivation of Liberty Safeguards (DOLs) applications had been made.

Is the service effective?

The provider had complied with the requirements of the Mental Capacity Act 2005.

Records showed, and staff confirmed, that staff had received training to meet the needs of the people living in the home.

Is the service caring?

This was a follow up inspection and we did not inspect under this question as we had determined that the service was caring during our previous inspection in April and May 2014.

Is the service responsive?

We found that the interim manager had responded to concerns raised during an internal quality audit and to non-compliance identified during our previous inspection. There were improvements to the service a s a result.

People using the service had access to activities outside the home which they had chosen. On the day of our inspection everyone using the service attended a day centre for a special event.

Is the service well led?

Quality assurance processes such as regular auditing were in place. Staff and people using the service were able to give feedback at regular weekly and monthly meetings.

For this inspection, we spoke with the registered manager and operations director, three staff members, a care manager and four relatives. The first part of the inspection was a visit to the home. The second part of the inspection involved telephoning relatives, staff and a care manager from adult social services to ask for their views of the service. We did this because people using the service had complex needs and those who would have been able to describe their experiences of care were out of the home during our visit. During the site visit we sampled the records of five people using the service and observed interactions between people and staff.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Relatives and the care manager from adult social services said they were confident that people using the service were treated with respect and dignity by the staff. We observed good interactions between staff and people using the service and staff understood how to protect people from abuse.

All staff we spoke with understood that people had the right to make their own decisions about their care. Not all had completed recent training in the Mental Capacity Act 2005 and were unsure about how to assess people's capacity. Although the provider had carried out mental capacity assessments relating to medical procedures there was not a robust system in place for assessing people's capacity for making other decisions about their care. This meant it was not clear how the provider judged that people needed supported 'in their best interests' or concluded that some people did not have the capacity to make specific decisions. This meant there was a risk that people were not being supported in line with the legislation relating to consent, and we judged the service was not compliant with this essential standard. Procedures in relation to the Deprivation of Liberty Safeguards were about to be reviewed in the light of recent changes to the legislation.

There was a system in place to make sure the manager and staff learnt from events such as accidents, incidents and investigations. This reduced risks to people and helped the service to continually improve.

Procedures for the safe management of medicines were not always followed which meant people were at risk of not receiving their prescribed medications. We judged the service was not compliant with the essential standard relating to medicines management.

Is the service effective?

People's health and care needs were assessed with their involvement and that of their representatives. People's specific mobility and communication needs were assessed and people's care was informed by appropriate professional advice from healthcare professionals.

The premises had been sensitively adapted to meet the needs of people with physical impairments whilst retaining a homely environment.

Staff had completed their mandatory training however they had not received regular supervision. This meant that staff were not given sufficient opportunity to discuss any issues relating to their roles or review their specific training and support needs.

Is the service caring?

People were supported by kind and attentive staff and relatives said the staff were excellent. We saw that care workers understood how best to support and encourage people and we observed people appeared happy and relaxed. Relatives were positive about the care provided, and we heard comments such as '[Their relative] couldn't be at a better place,' 'It's a very loving and caring home' and 'It's friendly and welcoming'.

People's preferences, interests and needs had been recorded and care was provided in accordance with people's wishes. Staff were able to recognise and explain how people liked to be supported.

Is the service responsive?

People had access to a range of activities including a specialist day centre as well as local pubs and the cinema. However, we were told that sometimes additional activities and day trips had been cancelled because there were not enough staff available to drive the specially adapted minibus.

Relatives we spoke with said if they had concerns they raised them with the manager directly. They also told us that they observed that staff responded to people's needs promptly to ensure they were comfortable and content. We found the service had received no formal complaints in the past year, and the service had received a range of compliments.

The service sought medical advice or assistance in a timely way and staff were aware of people's medical needs.

Is the service well led?

The service had recently introduced a quality assurance system, which meant that records and systems were self-assessed by the manager and then scrutinised by others. However, when we visited, the provider had not notified the Care Quality Commission that the registered manager was leaving, and plans had not been communicated about how the home would be managed thereafter.

The provider had not recently sought people's views of the service, and there was no record of actions being taken in response to the last survey. Relatives were concerned that the manager was about to leave and they had not been advised of future management arrangements. This meant there was a lack of confidence about the continued management of the home and the potential risk to people's welfare.

Staff said they worked well as a team, but they too were unsure about future management arrangements. This indicated that systems were not in place to take account of people's views or those of relatives and staff to identify, communicate and implement improvements.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance and risk management.

We observed that staff checked with people before providing any care or support to make sure that they were happy with what was planned. Staff understood that people could withdraw their consent to care at any time and they would respect that. However we did not see any evidence of consent for certain medical procedures. There had been no consideration given to people's capacity to consent to these and no evidence that best interest decisions had been discussed or recorded.

During our visit we observed staff supporting people in a calm and patient way. We spoke with two staff who told us of the changes that had taken place recently. One of the staff told us: 'We feel better now we have a manager we have less pressure.' They went on to explain that they now had more time to spend supporting people.

Records were kept securely and could be located promptly when needed. During this visit we saw that people's files had recently been moved into the staff office. This meant that current information was no longer stored alongside out-dated, archived information.

We observed that people appeared happy and relaxed. They were well dressed in their own particular style. All the people's rooms were personalised and reflected their own interests, preferences and choices.

People were encouraged to be as independent as they were able with appropriate and discreet prompts from staff. One person told us: 'I do my own personal care.'

All staff all demonstrated a good knowledge of each person's care and support needs. A lot of information available about each person's needs. However we had concerns that some of the information may not be up to date as people's care and support needs had not been regularly assessed.

Three of the people we spoke with were able to communicate that they were happy with the care and support they received and felt safe living at Cordwainers. All staff all demonstrated a good knowledge of safeguarding vulnerable adults.

Staff told us that when they were short of staff people did not have the opportunity to go out into the community to take part in activities. One of the people we spoke with told us that they were hoping to arrange a holiday, however they said: 'I can't do it yet because we are short [of staff].'

The provider organised monthly service reviews, which audited different aspects of the service. We saw audits of, for example support plans, risk assessments, health and safety checks and fire checks.

When we looked at people's records, we found that information was inconsistent and records had not been reviewed and updated to provide accurate guidance for people.