About the service
We conducted an unannounced inspection at Connect House on 29, 30 and 31 October 2019. Connect House work closely with staff employed by CityCare partnership and Nottingham University Hospitals, to provide a service where people are enabled to access expert support from a range of specialist health professionals. It is a fast-paced service with multiple admissions and discharges each week. The service accommodates 56 people across two distinct units, Heritage and Garden. During our inspection the service was at full occupancy.
Heritage Unit is comprised of 23 short-term beds providing a reablement service, to people who have recently been discharged from hospital, to help them regain their independence. A range of health professionals including physiotherapists, occupational therapists and nurses support this. There are also five people who are long term residents in Heritage.
Garden Unit provides nursing care. 12 beds in Garden Unit are 'Discharge to assess' beds, which are for people who no longer require a hospital bed, but still require an enhanced level of healthcare. A further six beds in Garden Unit are dedicated to the care and rehabilitation of people who have experienced a stroke and the remaining 10 beds, are for people who require long term nursing care. Garden Unit is staffed by nurses and health care assistants who are supported by a range of visiting clinicians including GP's, consultants and specialist nurse practitioners.
Improvements had been made to how risks were assessed, managed and monitored. New and improved audits and checks were completed that enabled the manager and provider to have oversight of the service. Improvements had also been made to how incidents and accidents were monitored and there was a system to investigate, learn and improve when incidents occurred. The manager completed a monthly analysis to consider themes and patterns of incidents and this further supported them to have oversight of any merging risks.
Improvements had been made to the documentation and systems to record and monitor people’s food and fluid intake. There were some shortfalls in other internal documentation completed by staff, and information was not consistently updated. However, staff were very knowledgeable of people’s health conditions and support needs. Information sharing from external stake holders when people transferred to the service was also inconsistent. The manager was aware of the difficulties around documentation and information sharing and was taking action to address this.
People were safeguarded from the risk of abuse and avoidable harm and information was available for people of how to report any safeguarding concerns. Staffing levels were sufficient at the time of the inspection. Staff’s response to calls for assistance was monitored by the manager. It was acknowledged when information about people’s dependency needs transferred from hospital were not correctly shared, this impacted on staff’s ability to provide effective and timely care at times. The manager was taking action to address this concern.
People received their prescribed medicines when they should, and staff had the required information to manage and administer medicines safely. The prevention and control of infection was managed safely. There was sufficient equipment to meet people’s needs. Health and safety checks on the environment had not always ensured people’s needs were effectively managed.
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. Where people were unable to make specific decisions regarding their care, the Mental Capacity Act 2005 principles were applied. However, further training was required to enhance understanding in the assessment and best interest decision making process.
Improvements had been made to staff training and support, the manager agreed to make further improvements to ensure staff training was completed in a timely manner.
Where people required support from staff with eating and drinking, staff were caring and unhurried. This supported people to have a positive mealtime experience.
People received care and treatment from staff who had a kind, caring and person-centred approach. Staff treated people with dignity and respect and their choices and decisions about how they received their care was upheld.
People’s communication needs were known and understood by staff, but some people experienced inconsistencies in the support they received. Advocacy information was available for people. People received opportunities to participate in social activities, but improvements were required to ensure these reflected people’s interests, hobbies and diverse needs.
People had access to the provider’s complaint policy and procedure and complaints were acted upon quickly. People’s end of life care and wishes had been assessed and planned for.
People were invited to share their views and wishes about the service they received, and staff felt involved in the development of the service.
The provider had met their registration regulatory requirements. Whilst the manager was new in post, they had worked at the service since April 2019 as the deputy manager. They had contributed to the improvements made at the service. They were positive and committed about the need for improvements to be sustained and what areas required continued development.
Rating at last:
At the last inspection the service was rated Requires Improvement (published 20 October 2018) and there were two breaches in regulation. 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.
For more details, please see the full report which is on the CQC website at ww.cqc.org.uk
Why we inspected:
This was a planned inspection based on the rating of the last inspection.
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.