3 December 2014
During a routine inspection
This inspection took place on 3 December 2014, was unannounced and was carried out by two inspectors over one day. One of the inspectors had specialist knowledge of people with learning disabilities, who may also have behaviours that challenge and communication needs.
The service was incorrectly registered with the Care Quality Commission. Their registration stated they were providing accommodation and nursing or personal care in a further education setting. This was not the case; the service was not a further education setting. The service was also registered to provide personal care and a diagnostic and screening service when they were not providing these services. The provider is in the process of resubmitting their registration to correct this and this is being dealt with outside of the inspection process.
St Gabriel's House – Apartments and Dane End offers care and support for up to 14 young adults with a learning disability and sensory impairment. Some people were deaf and were not able to see or talk. Others were deaf with some speech or could lip read. St Gabriel's House consists of two self-contained apartments accommodating up to four young adults in each; Dane End is a detached five bedroom property a few minutes' walk from St Gabriel's House. Dane End provides accommodation for up to five young adults developing their independence. On the day of our inspection there were 12 people living across service. One of the spare rooms at St. Gabriel’s was being used at week-ends for respite care.
There was registered manager working at the service. They were registered for St Gabriel's House apartments and Dane End. A registered manager is a person who has registered with the Care Quality Commission 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 Care Act and associated Regulations about how the service is run.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some of the people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. We received information from the service informing us that eight people had applications granted to deprive them of their liberty to make sure they were kept as safe as possible. There were records to show who their representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.
Each person had a care plan which was personal to them and that they or their representative had been involved in writing. The contents, information and quality of care plans varied. Some care plans were clear and precise, while other care plans did not record all the information needed to make sure staff had guidance and information to care and support people in the way that suited them best. Some plans did not contain / have information of the steps the person has achieved with their aspirations and goals. Plans for behaviours that challenge did not support positive behaviour but made judgements about people’s behaviour. Potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the support they needed to keep them as safe as possible.
People's medicines were not always handled and managed as safely as they could be. Some medicine records were not accurate. There was a lack of detailed guidance for medicine needed on a 'when needed' basis. The staff at Dane End had information to hand to tell them about the drugs they were administering and the possible side effects.
Staff told us about the training they had received. New staff received an induction and had access to range of training courses. The training records were not up to date and did not reflect the amount of training the staff had received.
The registered manger was restricted and unable to manage with autonomy due to the systems that had been implemented by the provider. The registered manager did not have easy access to all the information about the service as this was kept at head office.
A system of recruitment checks were in place to ensure that the staff employed to support people were fit to do so. Staff received appropriate safety checks before working with people to ensure they were suitable. Staff received regular supervisions and support where they could discuss their training and development needs. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. People said there was enough staff to take them out to do the things they wanted to.
People had an allocated keyworker who was involved in their assessments and reviews. A key worker was a member of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between staff. The key worker was a member of staff who the person got on well with and were able to build up a good relationship with. Whenever possible people were supported and cared for by their keyworker. People knew who their keyworker was.
Safeguarding procedures were in place to keep people safe from harm. All of the people told us they felt safe in the services; and if they had any concerns, they were confident these would be addressed quickly by their keyworker or by the registered manager. All staff had been trained in safeguarding adults, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the registered manager or outside agencies if necessary.
People were offered and received a balanced and healthy diet. People could choose what they wanted to eat and when they wanted to eat it. People said that they enjoyed the food and told us what their favourite things were. People looked healthy and had a wide range of foods to cook and prepare. People’s rooms were personalised and furnished with their own things. The rooms reflected people’s personalities and individual tastes.
Staff were aware of the ethos of the home, in that they were there to work together to provide people with personalised care and support and to be part of the continuous improvement of the service.
The registered manager asked people for their opinions on the quality of care they received and responded to comments and complaints received in a timely and appropriate way. People’s opinions and preferences mattered and were respected. There were appropriate management arrangements in place and staff and people told us they had no problems in talking to registered manager about any concerns. People were actively involved in developing the service by giving their views through regular meetings with their keyworker other staff and the registered manager. Regular health and safety audits were carried out to ensure the safety of the premises.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.