24 November 2014
During a routine inspection
The inspection took place on 24 November 2014 and was announced. We provided the registered manager 24 hours’ notice of the inspection. This was because the manager is often out of the building supporting staff at other locations. We needed to be sure that they would be in. 52-60 Grosvenor provides personal care and accommodation for up to eight people with learning disabilities. At the time of the inspection there were six people using the service.
There was a registered manger in post. 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 2008 and associated Regulations about how the service is run.
Staff were aware of the signs of abuse and were able to tell us how they would escalate an allegation of abuse. People did not always receive a service that was safe and met their needs. Risk assessments were in place for people with a plan in place to manage those risks. Staff did not always take into account professional recommendations in the management of risk; this increased the likelihood of risk occurring to people.
The service recruited and employed suitably qualified staff to care for people; newly appointed staff were supported to develop their experience so they were able to meet people’s care needs.
Medicines were not always managed safely. Medicines administration records were not kept up to date and we found expired medicines in the medicine cupboard.
Staff had access to regular training to update their skills and knowledge and to equip them in their caring roles. Staff had regular supervision and an appraisal. Staff discussed personal and professional development needs and a plan was put in place to meet those needs.
Staff were aware of their responsibilities within the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs). People and their relatives were supported by staff to make decisions and to consent to care and support. Staff were knowledgeable in working with people with complex care needs, and referred people to health and social care services for support and advice to meet those needs.
We saw staff interact and engage with people, where people were unable to communicate verbally; staff used non-verbal communication methods which people understood. Staff understood the care, support and wishes of people and these were respected. People were encouraged to make decisions for themselves, as able, and staff helped people to achieve their goals. People’s confidential care records were stored safely and staff had access to these when needed.
People had assessments before coming to live at the service and whilst they were living there. People and their relatives were encouraged to be involved in assessments and care plan development. Care and support was delivered in line with their assessed needs, care plans were developed from this information so that people received appropriate care to meet their needs. These were regularly reviewed and updated as required. People and their relatives were asked for feedback on the quality of the service and staff acted on those responses to improve the care delivery for people. People were provided with information on how they could make a complaint and how the complaint would be managed.
The registered manager was aware of their role and responsibilities of managing the service and with their registration with the Care Quality Commission. During team meetings the registered manager provided staff with service updates. Incidents and accidents were discussed with staff in meetings to support their learning and to improve care and support for people.
Staff carried out regular quality audits. Medicines audits were carried out at each shift change. However, we found there was no overall medicines audit for the service and medicine errors could not always be detected. We found the medicines audits completed had not recognised there were expired medicines stored in the medicine cupboard. This medicine could be used in an emergency for people who were at risk of a sudden deterioration in their health. People were at risk of a significant impact to their health and well-being if they received this medicine.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.