Archived: 148 Hornsey Lane

148 Hornsey Lane provides accommodation and personal care to people with long-term mental health needs. The service accommodates 12 people across three floors. At the time of our inspection there were 11 people using the service.

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

During this inspection we found that the management team needed to improve the oversight of the service provision. The provider needed to ensure that all aspects of the service were regularly and effectively monitored and that the service was provided in line with the current government guidelines and legislation.

We found improvements had been made in relation to the infection prevention and control, risk assessment, management of medicines and staffing. There remained some areas of improvement still to be achieved in seeking feedback from people and relatives.

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 and relatives said people usually felt happy and safe at the service. We received concerns about how safe the home was in keeping people safe for visitors bringing in COVID-19 and how much information was shared with relatives. External health and social care professionals said that staffing had been a concern due to staff turnover and that some people’s mental health should be able to be responded to in house rather than seeking community mental health colleague’s advice.

The recruitment procedures for staff employed directly by the provider, and from external staff agencies were now safe as, not least for externally recruited staff, the provider was verifying staff background checks. Staff we spoke with understood their role in safeguarding people from harm from others. There were appropriate accidents and incidents procedures in place.

The registered manager understood their legal responsibility around being open and honest with people when something goes wrong and notifying the CQC about significant events at the service. However, we were concerned that a significant event that had happened a few days prior to our visit was not mentioned to us when we were at the home. This had been raised by a senior manager the following day and CQC had been notified via CQC’s notification system.

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 requires improvement (published 8 January 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve to comply with a warning notice. The warning notice had been issued in relation to infection prevention and control. Our previous inspection also found breaches of regulation 12 in respect of risk assessments, fire safety and medicines. There were also breaches of regulation 17 regarding good governance and regulation 18 in respect of staffing.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations and had complied with the warning notice.

Why we inspected

The inspection was prompted to follow up on compliance with the warning notice that had been issued after our inspection in November 2020. A decision was made for us to inspect and examine this and the previous breaches of regulation.

The inspection was prompted in part due to concerns received about protecting people from COVID-19, information sharing, treating people with dignity and respect, staff turnover and managing people’s mental health issues. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider had made improvements but they also acknowledged that more could be done.

The overall rating for the service has not changed from requires improvement. This is based on the findings at this inspection.

Follow up

We will work alongside the provider and local authority to monitor progress.

148 Hornsey Lane provides accommodation and personal care to people with long-term mental health needs. The service accommodates 12 people across three floors. At the time of our inspection there were 11 people using the service.

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

During this inspection we found that the management team needed to improve the oversight of the service provision. The provider needed to ensure that all aspects of the service were regularly and effectively monitored and that the service was provided in line with the current government guidelines and legislation.

We found improvements were required in relation to the infection prevention and control, risk assessment, management of medicines and staffing. Further areas for improvement related to analysing and acting on feedback from people and overall monitoring of the service. We noted that improvements had been made between our visits on 5 November and 20 November and these were related to infection prevention and control.

People and relatives said people felt happy and safe at the service. External health and social care professionals said staff were kind and caring.

The recruitment procedures for staff employed directly by the provider were safe. Staff understood their role in safeguarding people from harm from others. There were appropriate accidents and incidents procedures in place.

The registered manager understood their legal responsibility around being open and honest with people when something goes wrong and notifying the Commission about significant events at the service.

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 (report published 17 April 2019)

Why we inspected

The inspection was prompted due to concerns received about infection prevention and control measures at the service. A decision was made for us to inspect and examine those risks.

We found evidence that the provider needs to make improvements. Therefore, we made the decision to widen the inspection to a focused inspection to review the key questions of safe and well-led. We carried out a second inspection visit. Please see the safe and well-led domain sections of this full report.

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

Enforcement

We issued a warning notice in relation to infection prevention and control. We identified breaches in relation to infection prevention and control, medicines management, assessing risk, staffing and the governance of the service. We made one recommendation about customer satisfaction surveys.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

148 Hornsey Lane provides accommodation and personal care to a maximum of 12 adults with long-term mental health needs. At the time of the inspection ten adults were living in the care home.

People’s experience of using this service:

People using the service told us they felt safe in the home and staff were kind, caring and respectful. They spoke positively about living in the home and raised no concerns. People’s relatives were also positive about the care provided by staff and said that staff treated people with respect and dignity.

Staff took appropriate action to ensure people were safe from avoidable harm and abuse. Systems were in place, which ensured that people were living in a safe environment and risks to their health and wellbeing were regularly assessed. These related to regular health and safety and fire checks, infection control and management of incidents and accidents.

Staff had received training on how to identify abuse and understood their responsibilities in relation to safeguarding people, including reporting concerns relating to people's safety and well-being. Risks to people had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised.

Systems were in place to ensure that people received their prescribed medicines safely. Medicines were stored and managed well. Staff had received medicines administration training and their competency was assessed to ensure they knew how to administer medicines safely.

On the day of the inspection we observed that staff did not appear to be rushed and were able to complete their tasks. We discussed staffing levels with the registered manager and she explained that there was flexibility in respect of staffing and staffing levels were regularly reviewed depending on people's needs and occupancy levels.

People were supported to live a healthy life. Staff supported people to have a healthy and nutritious diet that was in line with their individual dietary needs and preferences. People had access to healthcare professionals when needed.

People's care and support plans were up to date and personalised. They included details about people’s individual needs and preferences and guidance for staff to follow so people received personalised care and support that met their individual needs and preferences.

Staff received appropriate training to ensure they had the right knowledge and skills to support people in a safe and effective way. The registered manager supported staff by providing them with regular supervision and a yearly appraisal of their performance.

Staff knew people well and had a caring approach to their work. They understood the importance of treating people with dignity, protecting people's privacy and respecting their differences and human rights. During the inspection, we observed staff treated people with respect, kindness and compassion. Positive caring relationships had developed between people who used the service and staff and people appeared at ease in the presence of care support workers and the registered manager.

The home was designed to enable people to spend their time on their own or in the company of others. There were communal areas to socialise with other people using the service and individual rooms to spend time on their own if preferred. The décor was homely and we saw people were comfortable in their environment.

Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff gained people's agreement before providing them with assistance with personal care and other activities.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. The home had made necessary applications for DoLS.

Staff encouraged and supported people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them. Activities available in the home included massages, music appreciation, movie nights and bingo. There was also a relaxation room available to people where they could spend some time alone if they wished.

People received care that was in line with their care needs and individual preferences, which were described in comprehensive care plans. Care plans included guidelines for staff on how to support people effectively.

There was a formal complaints procedure in place which was available to people. People told us they had not had any complaints and they felt listened to by staff and the registered manager.

The home had a management structure in place with a team of care support workers, senior support worker and the registered manager. Staff told us that the morale within the home was good and that staff worked well with one another. Staff thought the service was well led. They felt supported by the registered manager who they described as approachable and willing to participate in support worker's tasks to help when needed. There was good communication between staff members at the service. Effective systems were in place to ensure formal discussions were recorded and agreed actions were followed. Staff were encouraged to participate in the running of the service. This gave them the opportunity to lead on allocated areas of responsibility and to develop their professional skills and knowledge.

Management monitored the quality of the service and we saw evidence that regular audits and checks had been carried out to improve the service. Audits and checks had been carried out at regular intervals in areas such as care documentation, health and safety, equipment, cleanliness of the home, medicines management and staff training.

There were regular residents' meetings taking place at the service. In these meetings, people were encouraged to voice their opinion about the support they received and participate in decision making about day-to-day matters related to living at the service.

Rating at last inspection: The service was previously owned and managed by another organisation and had been inspected in February 2018 and rated as Good. A different organisation took ownership of the service in April 2018. This inspection in March 2019 was the first inspection for the service under the new provider ownership.

Why we inspected: This was a scheduled planned comprehensive inspection.

Follow up: We will continue to monitor the service through the information we receive.

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