Underhall Respite and Resource Centre

Underhall Respite and Resource Centre is a residential care home providing personal and nursing care to up to 14 people. The service provides short term respite placements as well as permanent placements. The service provides support to older people, including those with dementia, people with physical disability, sensory impairments and mental health needs. At the time of our inspection there were 14 people using the service.

The home is based on a single level, with communal lounges and dining spaces as well as a pleasant outdoor garden.

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

Medicines were not always managed in line with best practice guidance.

The provider’s governance systems in place were not always effective in identifying areas for improvement.

The registered manager and staff understood people’s risks and how to support them safely, however this information was not always clearly recorded.

People felt safe at the service and there were enough staff to meet both the care needs and emotional needs of people.

People had a good relationship with staff and the registered manager and told us they felt listened to. There were opportunities for people, their relatives and staff to feed back into the running of the service.

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 for this service was requires improvement (published 12 April 2019) and there were breaches of 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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider makes improvements in relation to the management of medicines. At this inspection we found the provider had not made the necessary improvements required and was now in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 26 February 2019 and breaches of legal requirements were found in relation to governance and fit and proper persons employed. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Underhill Respite and Resource Centre on our website at www.cqc.org.uk.

Enforcement

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 breaches in relation to safety and 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.

Underhall respite and resource centre is a residential care home that also provides a short-breaks (respite service) to older adults. The service also provides a day service, which was outside the scope of consideration for this inspection. The home is based on a single level and there is parking outside the premises. The service is registered to provide care and support to up to 14 people.

People’s experience of using this service:

• The service was caring and provided people with person-centred support. However, there were some shortfalls in relation to records and systems and processes to help monitor and improve the quality and safety of the service.

• People received support from a small, consistent staff team. There were numerous examples of where the service had gone ‘above and beyond’ to provide people with support that met their needs and preferences.

• The registered manager and staff had a good understanding of people’s needs and social histories. They used this information to provide person-centred support. However, care plans did not always reflect the information known to staff.

• We found staff took reasonable actions to help keep people safe from harm. However, there was limited formal, recorded risk assessment.

• The registered manager aimed to provide a ‘homely’ service, and demonstrated caring values that were reflected by the staff team.

• The registered manager had a good oversight of the service. However, this was not always reflected in the records or by systems and processes in place to assist them in monitoring the service. We found this to be a breach of the regulations.

• People received their medicines as prescribed. However, there were some shortfalls in relation to records kept, and requirements in relation to the safe storage of medicines. We have made a recommendation in relation to the management of medicines.

• We identified some shortfalls in relation to the implementation of the Mental Capacity Act (MCA), primarily in relation to records kept. We have made a recommendation in relation to implementing the MCA.

• People were positive about the kind and caring nature of staff. Whilst we did not identify any concerns about the staff employed, we found there were gaps in the processes followed to ensure staff recruited were of suitable character. We found this to be a breach of the regulations.

• We received positive feedback about the food provided. The service took people’s dietary requirements and preferences into account when preparing meals.

• The service had good working relationships with other health and social care services. We received positive feedback from social care professionals with recent involvement with the service.

• The provider was not always meeting regulatory requirements. We found required notifications in relation to expected deaths had not been submitted as the provider was unaware of this requirement. Prior to the inspection, the service had breached conditions of its’ registration with CQC by admitting more people to the service than it was registered for.

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

Rating at last inspection:

This is the first time we have inspected this service.

Enforcement/improvement action:

Please see the ‘action we have told the provider to take’ section towards the end of the full report.

Follow up:

• We will request an action plan from the provider setting out how they intend to make improvements to meet the requirements of the regulations.

• We will continue to monitor the service.