Archived: Housing 21 - Stanbridge House

Housing 21 - Stanbridge House is an extra care housing scheme. The scheme comprises of ten one-bedroom flats and sixty two-bedroom flats. People had a range of needs including older people and people with a physical disability. They received support with their personal care, support with medicines, food shopping and cleaning. People could also be visited by care workers from other external providers. At the time of the inspection 25 people were receiving support with personal care.

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

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

People were happy with the support they received. They could contribute to the type of support they received and were a part of the development of their support plans. Information in people’s support plans was informative and person centred, giving staff details on how the person wanted to be supported. People using the service were supported to access activities in the service and go into the community to reduce the risk of social isolation.

People felt safe living at the service and were supported by staff who knew how to protect them from harm and abuse. The provider had a complaints process in place and people told us they knew what to do if they wished to raise any concerns. Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines as prescribed.

People were supported to eat a healthy diet and to access health care professionals when required.

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.

Staff were positive about working in the service and confirmed they received ongoing support and training. The service had a clear management and staffing structure in place. Staff worked well as a team and understood people’s needs. The provider had quality assurance systems in place to monitor the quality and safety of the service.

The provider had processes in place for the recording and investigation of incidents and accidents.

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

Rating at last inspection The last rating for this service was good (published 10 July 2017).

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.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

At our previous inspection on 30 March 2015 we found that records relating to peoples care were not always up to date and accurate. This was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Since our last inspection we found the service had made improvements to ensure that people’s care records were up to date and accurate.

The service was responsive to people's needs and ensured people were supported in a personalised way. Staff understood people's needs and preferences. People's needs were assessed to ensure they received personalised care. People were encouraged and supported to avoid social isolation.

There were sufficient staff to meet people's needs. People told us there were enough staff to meet people’s needs. Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. People received their medicines as prescribed.

People continued to receive effective care from staff who had the skills and knowledge to support them and meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

The service continued to provide support in a caring way. People benefited from caring relationships with staff. People were involved in decisions about their care needs and the support they required to meet those needs.

The service was led by a registered manager who promoted a positive culture that valued people, relatives and staff.

At our last inspection in January 2014 we found that the provider was not meeting the standards required in relation to management of medicines. The provider told us what action they were going to take to improve. This was a responsive follow up inspection to ensure improvement had been made. The inspection team comprised an inspector for the service and a pharmacist inspector. We found that whilst some improvement had been made some improvements were still required.

At the time of our inspection 26 people were receiving a personal care service. We spoke with five people and one relative. At the time of our inspection the service did not have a registered manager in post as required. We met with the interim manager for the personal care service, and we spoke with the care team leader and senior care worker, four care workers, the housing extra care court manager and their deputy manager.

We considered our inspection findings to answer the questions we always ask;

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

This service was not always safe. Appropriate arrangements were not in place for the safe administration of medicines, for example, allergy status of people was not on their medication administration record (MAR) charts and therefore not easily available to care staff administering medication.

We were not assured that the provider always responded appropriately to allegations or signs of abuse. We saw in the incidents and accidents folder an incident documented on 8 June 2014. On the incident and accident form it stated that safeguarding had been informed. We spoke with a senior member of staff they were unable to tell us what had happened as a result of the alert having been made. We looked in the safeguarding folder and found no record of the alert made or what had happened as a result. The service had also not alerted the care quality commission of this occurrence in line with the necessary requirements.

Is the service effective?

We found the service was not always effective. People we spoke with were satisfied with the service. One person said 'I'm very pleased with what they do'. Another person said 'I'd recommend this place to anyone; I think it's very satisfactory'. Another person indicated there had been a few issues with the timing of visits but said the service had 'got there at last'.

We saw that care workers were trained in specific tasks where required. For example; care workers had been specifically trained to be able to detach and re-attach a feeding tube in order to deliver personal care to one person. We saw that this training had been provided to staff by a specialist nurse. We spoke with care workers who told us they had received training for this specific task. We also spoke with the person who used the service they told us that staff were suitably trained to carry out this task and that they had 'no issues'. This showed us people's needs were appropriately met by care staff who received specialist training where required.

Is the service caring?

We found this service was caring. People were treated with dignity and respect. We spoke with people who used the service, they told us that staff were polite and treated them with dignity and respect. For example one person said 'I'm very pleased with what they do, they are very nice and polite'. Another person said staff were 'very nice, very kind'.

We saw care staff interacting with people in a kind and respectful manner. Care workers knocked on people's doors and waited for the person to answer before entering the room. We saw staff taking time to speak with people in the communal lounge areas, asking them how they were and talking about the person's day; for example; one person was having a conversation with a care worker about the bingo they were looking forward to playing that evening.

Is the service responsive?

We found this service was not always responsive. We looked at the complaints folder; this contained one letter of complaint from March 2014. We saw no records to show how the complaints procedure had been followed to investigate this complaint or what the outcome of the complaint was. This meant we found no evidence that the provider had an effective system in place to deal with complaints. There was also no evidence of a system in place to monitor and review complaints to inform service delivery.

We spoke with care staff about the care they provided. They gave us examples of how they respected people's dignity and privacy when providing personal care and support. For example, one care worker told us that one person prefers to wash, but that they always ask whether they would like a wash or a shower'. Another care worker gave us an example of respecting a person's privacy and by covering the person appropriately with a towel, and by asking the person if it is alright to help dry them after their shower.

Is the service well led?

The service had been without a registered manager since May 2014. By law this service is required to have a registered manager, therefore, we could not say this service was well led.

We found the provider did not have an effective system in place to regularly assess and monitor the quality of the service that people received. The views of people and relatives were not routinely sought to quality assure the personal care service provided. Surveys were not carried out in relation to personal care services delivered. We saw that monthly spot checks had been used in the past to seek views of people who received a personal care service; these had not been done since February. Whilst regular meetings were held with residents these meetings focussed on aspects of the extra care housing facility such as social activities; they did not cover any aspects relating to the personal care service. We spoke with the interim manager about this. They told us they will be attending the monthly coffee mornings with residents from June 2014 onwards to obtain feedback in relation to the care provided.

We were told that care plans were routinely updated on a six monthly basis or as required when changes occurred. However, we found no system in place to monitor care plans to ensure they were updated on a six monthly basis or as required. This meant that the provider did not have a system in place to assure themselves that care records were kept up to date.

We had received concerns relating to the management of medicines by this service and therefore the service was inspected by a pharmacist inspector. We looked at the processes, procedures and records held by the service relating to the use and management of medicines. We also reviewed the supply process, supporting information and administration records.

We found that medicines had not always been obtained in a timely manner. The information to support care workers to administer medicines was incomplete and lacked detail. Therefore we could not be assured that staff less familiar with the people would administer the medicines in a consistent manner. We found that medicine administration records were at times incomplete and were not always completed in line with the service's medication recording procedures.

We found that the service undertook medicine audits and incident investigations. We were concerned that audit data and incident investigation conclusions were considered independently from each other. It was not clear what learning had taken place from the audit and incident analysis to ensure that risks related to medication management had been identified and managed. Therefore we were not been assured that the medicines administration systems were monitored and modified to ensure people received their medicines as prescribed.

We spoke with two people who used the service and two relatives during our inspection. We visited these people in their homes to gather their views. We also spoke to three staff members.

People told us that they felt safe and secure when receiving care from staff. We found the agency had developed suitable arrangements to protect people from the risk of abuse. Staff we spoke with knew how to identify abuse and how to implement the local safeguarding procedures. We found that any identified or suspected abuse was addressed appropriately.

We found staff received training and regular supervision to support their professional development. Systems had been put in place to monitor staff's competency to undertake their care tasks. This meant that people could be assured that they were cared for by appropriately skilled staff.

We found that systems had been developed to enable the manager to monitor the quality of the service provided and to identify and respond to risks. We saw that the agency had completed a service audit on 17 July 2013 to measure the quality of the service and had made improvements as a result.

One person told us that they 'give the care needed before you ask'. Another person was concerned because the service had not provided him with a bill and he was worried 'I owe several thousand pounds'. As this had been going on for some time this was causing him undue stress as he was self- funding. A later check with the area manager confirmed that bills were now being sent out.

Support staff told us that they had not had support or supervision from senior managers for some time. The registered manager had been off on long term sick leave and they told us that no support was available to them during this period.

People told us that they were asked to comment on the quality of the service being provided and that the manager made spot checks to monitor the care being provided.