Archived: Redwood Glades

About the service

Redwood Glades is a domiciliary care agency providing personal care within an extra care housing facility. The service provides support to people with a range of different needs, including people who have a learning disability.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This means tasks related to personal hygiene and eating. Where they do we also consider any wider

social care provided. At the time of the inspection, there were 113 people who were receiving personal care calls.

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

The service did not consistently assess and mitigate risks to people. Accidents and incidents were investigated, but it was not clear if risk assessments were updated where increased risk was indicated.

The quality assurance system in the service did not identify this and care records were not always up to date. We found that no direct harm had come to the people, but the risk of harm had been increased. We have made recommendations about risk assessments and audits.

Staff had received introductory training in mental health and additional training was provided where required. We identified further training was need for staff to support people with more complex needs and the provider committed to supplying this.

The provider recruited staff safely and used a dependency tool to ensure there were enough staff on duty to meet people’s needs.

Staff supported people with their medicines. The registered manager had addressed any concerns through safeguarding and audits and closely monitored the use of any 'when required' (known as PRN) medicines to ensure the best possible outcomes for people.

Most people in the service told us that they were very happy, and staff supported them well.

Staff understood how to protect people from poor care and abuse because they knew people well.

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 Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 12 July 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led relevant key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Redwood Glades on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This means tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, there were 111 people who were receiving personal care calls.

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

People told us they felt safe with staff and trusted them. Staff were recruited safely, and employment checks were completed before they started working alone with people. Staff knew how to safeguard people from the risk of abuse and poor practice and knew how to raise concerns. Risk assessments were completed to guide staff in how to minimise the risk of incidents and accidents without being overly restrictive.

There were enough staff to complete the care calls. Staff completed a five-day induction followed by updates in training to ensure they had the right skills and felt confident when caring for people. There was a system of supervision, ongoing competency assessment and annual appraisal for staff to monitor their development and support needs.

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. People told us staff looked after them well and respected their privacy and dignity. There were positive comments about staff approach and how they respected people’s lifestyle choices and diverse needs.

People who used the service were supported to access health care professionals when required and to maintain a healthy diet when this was part of their care plan. Staff supported people to manage their medicines to make sure they were taken as prescribed.

Care plans were comprehensive and had been completed with people’s involvement. They described people’s preferred routines and how they would like care to be delivered. Staff told us care plans had improved and guided them to provide person-centred care. There was no-one receiving end of life care at the time of the inspection. However, staff described how care plans would be adjusted to include end of life care and how they would work with health professionals to ensure people could remain in their home.

The provider’s quality monitoring system had improved. Audits, surveys and meetings were completed, feedback was listened to and shortfalls addressed. People told us they were confident complaints would be listened to and resolved. Staff said they could raise issues with the registered manager and found them supportive.

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 31 May 2018). At the time, there were concerns with safe administration of medicines, risk management, 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.

This 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. 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.

People who used the service lived in a large building which had 156 individual flats. At the time of the inspection, there were 10 vacant flats. Hales Group Limited provided domiciliary care to people with a range of needs. These included people with mental health needs, physical difficulties, those who were living with dementia, older frail people or those who had a learning disability. Not everyone using Redwood Glades received 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, 118 people were receiving the regulated activity of personal care from Hales Group Limited.

The service had a registered manager in post. 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 throughout the service in relation to medicines management, quality monitoring of the service, records and staff support, supervision and training.

We found people had not always received their medicines as prescribed. There had been a number of errors with medicines management and staff were to receive additional training and competency checks.

Improvements were required in risk management to ensure all areas of risk were identified and included in care plans to help staff minimise risk of incidents and accidents.

The unit manager told us part of the internal quality monitoring system had ceased in October 2017 as they concentrated on an influx of admissions to Redwood Glades. This meant any audits that were completed were carried out in a reactive rather than a planned way, for example to address errors in medicines management. This meant care plan and risk assessment deficits had not been identified and addressed quickly. Seven day and six-week reviews with people who used the service had taken place, which was part of the audit system.

Records were not comprehensive, especially those describing the care required to support people in a safe way. There were also some gaps in recording decisions relating to people’s capacity. We have made a recommendation about the application of the Mental Capacity Act 2005.

The above 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) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were needed to make sure staff received formal supervision to check their progress and development. We have made a recommendation about this.

Staff were recruited safely and in numbers sufficient to meet people’s needs. The registered manager told us staff were recruited and allocated to calls on the basis of the number of care hours requested by commissioners. There had been an initial issue when admissions to the service outpaced staff recruitment, but the registered manager told us they were fully staffed now and admissions almost completed. There were concerns raised by some people about the timings of care calls and the length of time staff were given between calls to ensure this gave them sufficient time to move about the building. The registered manager told us they would look into this.

Staff had received training in safeguarding people from the risk of abuse. They knew the signs and symptoms to look out for and how to alert relevant people.

Some people told us there had been issues with staff attitudes and, at times, their privacy had not been respected and preferences not adhered to. The registered manager was aware of this and had arranged additional training for staff. Other people were very happy with the care provided by staff and had built up good relationships with them.

Staff supported people to access healthcare professionals when required and monitored their health and nutritional intake when risk had been identified. Some people required only minimal assistance with meal provisions, whilst others needed close monitoring to ensure their meals were eaten and they had sufficient fluids. Staff completed food and fluid monitoring charts for those people at risk.

The provider had a complaints policy and procedure, which was given to people when they accessed the service. People told us they felt able to raise concerns or they would speak to their relatives to raise them on their behalf. There were concerns that the office was not a private place to discuss complaints. The registered manager told us the staff training room was available for private discussions when requested and there was a weekly drop in session for people who used the service and relatives to allow individuals to discuss concerns or complaints.

The registered manager, unit manager and staff told us the culture of the organisation was open and they would be able to raise issues with senior management if required. There was an organisational structure with tiers of management and incentives to assist with staff retention.