Archived: Cecil Gardens

Cecil Gardens is an extra care housing complex providing 95 individual flats. Not everyone living there receives a regulated activity. The service can provide care and support to people living with dementia, learning disabilities or autistic spectrum disorder, mental health, older people, younger adults, people who misuse drugs and alcohol, people with physical disabilities and people with sensory impairment.

The Care Quality Commission only inspects the service being received by people provided with ‘personal care’, for example, help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of the inspection, 68 people were receiving the regulated activity of personal care. There were also 94 people who lived in the surrounding area who also received calls for personal care from Hales Group Limited.

People’s experience of using this service and what we found

Since the last inspection, there had been improvements in medicines management, record keeping and quality monitoring. The quality of care records in relation to risk, consent and daily recordings had improved. Where people required support with their medicines this was managed safely; the number of medicine errors had significantly reduced.

The provider’s quality monitoring system had improved. Audits, surveys and meetings were completed, and shortfalls addressed. All feedback was used to make continuous improvements to the service.

Staff were recruited safely. There were enough staff to complete the care calls. Most people confirmed they received care at their preferred times from their regular care staff, but at times some people had not received care from a consistent group of staff. We have made a recommendation about this.

People were supported to remain independent and access local activities within the community. People told us staff respected their privacy, although one person raised issues around staff access to their apartment, which we have passed to the registered manager to follow up.

People and relatives said the service was safe. They were supported by staff with the skills and knowledge to meet their needs. Staff had regular training and felt confident in their role. Risks to people’s health and wellbeing were assessed and mitigated. Where required, people had access to appropriate equipment and were supported to ensure their homes remained safe.

People were supported to maintain a healthy diet when this was part of their care plan. The registered manager had developed positive links with health care professionals which promoted people’s wellbeing.

People and family members told us staff were kind and caring and they felt at ease with them.

People felt listened to and told us staff had time to sit and chat with them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating and update for this service was requires improvement (published 23 November 2018). At the time, there were concerns with safe administration of medicines, records and ensuring a good quality assurance system.

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.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cecil Gardens 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. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. The CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

There are 95 individual flats in Cecil Gardens. Not everyone living there receives a regulated activity. The CQC only inspects the service being received by people provided with ‘personal care’, for example, help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of the inspection, 71 people were receiving the regulated activity of personal care from Hales Group Limited. There were also 63 people who lived in the surrounding area who also received calls for personal care from Hales Group Limited. Most were older people who had a range of needs, which included physical difficulties and those people who were living with dementia. However, there were other people who had mental health needs and a small number of people who had a learning disability.

The service had a registered manager in post, although a new person had been appointed as a 'care manager' and was in the process of applying for registration with CQC. The registered manager was to ‘de-register’ for this location once the process of registration with the care manager was completed. A registered manager is a person who has registered with the CQC 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 Act 2008 and associated regulations about how the service is run.

During this inspection, we identified shortfalls in relation to medicines management, gaps in recording and quality monitoring of the service. These issues were breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) 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 the report.

We found people had not always received their medicines as prescribed. There had been some administration errors and also recording omissions, which made it difficult to check if people had actually received them. Staff received additional training and competency checks. The recording errors had persisted although were reducing. This meant people remained at risk of harm as the provider could not be assured people were receiving their medicines in line with the prescribing instructions.

There was a quality monitoring system and audits had identified some shortfalls. However, the system had not identified other recording issues. These included mental capacity documentation, missing dates and signatures on important assessments, the lack of an important care plan update following a significant change in one person’s needs, no monitoring charts for pressure relief for a person at risk and some elements of risk identification. The quality monitoring had not identified a lack of time in-between care calls within Cecil Gardens.

Staff knew how to protect people from the risk of abuse and had completed training. They knew who to contact if they had concerns. Risk assessments were completed and steps put in place to minimise risk. Some risk assessments could have more information and guidance for care staff, which was mentioned to the care manager to address.

Staff supported people to meet their health and nutritional needs. They contacted health professionals when required and put in place plans to support people to make, and when required, eat their meals.

People told us staff supported them in a kind way and respected their privacy and dignity. They maintained confidentiality and ensured personal information was stored securely. People were supported to make their own decisions as much as possible. 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 support this practice.

Staff were recruited safely and employment checks were in place before they worked with people who could be vulnerable. There had been some issues with staff retention and the care manager told us recruitment was an ongoing process. The staffing levels had started to be more constant but were affected by issues such as long-term sickness and school holidays. The care manager told us the employment of ‘bank staff’ used when required to fill in gaps had helped the situation.

Staff had access to induction, training, supervision and support. The team leaders and care manager carried out spot checks of staff practice and assessed their competence in specific areas such as medicines management and moving and handling.

Staff described the registered manager, care manager and regional manager as supportive and approachable. They also described the culture of the organisation as open and willing to listen.

Staff were provided with personal protective equipment such as gloves and aprons, which helped them prevent the spread of infection.

The provider had a complaints policy and procedure, which was given to people when they moved into Cecil Gardens and received a service from Hales Group Limited. People told us they felt able to raise concerns.