Archived: Danesfield Supported Living Service

Danesfield Supported Living Service provides care and support for 15 people in their own homes including 24 hour care. This includes care and support for people with a learning disability, mental health problems and physical disabilities.

The service had a registered manager. 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.

Medicines care plans were not always accurate. For example, one person’s medicines care plan described a level of support the person had never received previously. Another person’s care plan contained conflicting information about the support they needed with medicines. Reviews carried out of these care plans had not identified the discrepancies. Both of these care plans had been re-written before our inspection had concluded.

Other records related to the receipt, administration and disposal of medicines were accurate and complete.

Incidents were logged and action was taken to help keep people safe. All of the incidents related to medicines errors. The number of errors had reduced due to the action the provider had taken.

Care workers had a good understanding of safeguarding and the provider’s whistle blowing procedure. They told us they did not have concerns about people’s safety but would not hesitate to raise concerns if required. Previous safeguarding concerns had been dealt with in line with the provider’s safeguarding procedure.

People were happy with their care and the care workers supporting them. They also felt the service was safe.

The quality of information and level of detail recorded in risk assessments had improved since we last inspected. Risk assessments had been completed across a range of areas such as medicines, finances and specific medical conditions.

People and care workers confirmed there were sufficient care workers on duty to meet people’s needs in a timely manner. Care workers also told us staffing levels had improved recently.

Effective recruitment procedures were in place to help ensure new care workers were suitable to work at the service. This included requesting two references and a Disclosure and Barring Service (DBS) check.

The provider had up to date procedures to deal with emergency situations and to ensure people continued to receive the care they needed.

Care workers were well supported and had access to training relevant to their caring role. Records we viewed confirmed supervisions, annual appraisals and essential training were up to date. Essential training included safeguarding adults, food hygiene, moving and handling and first aid.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA). Care workers supported people to make as many decisions and choices as possible. Care workers told us most people understood verbal communication and were able to make daily living choices.

People were supported to prepare meals and drinks in line with their individual needs. Support provided included help with preparing meals and advice about healthy eating. Nome of the people using the service required any practical assistance with eating and drinking or special diets.

People were supported to access health care when needed, such as support to make and attend appointments.

People's needs had been assessed and information gathered about their individual care needs and preferences. Personalised care plans had been written which people had checked to confirm they were happy with what was in their plan.

Activities were available for people to participate in both within Danesfield and in the local community. These included going to the shops, college, local day clubs, out for walks, swimming, visiting relatives, going to the pub, the pool club and the gym.

People did not have any concerns about their care but knew how to raise concerns if they were unhappy. There had been no complaints received since we last inspected the service.

People had opportunities to share their views about the service through attending regular meetings and questionnaires. Initial feedback from the most recent consultation was positive.

Care workers told us they were able to share their views and suggestions about the service, either speaking directly with the registered manager or during regular supervisions and staff meetings.

The current systems of quality assurance had not been effective in identifying that medicines care plans for some people were inaccurate.

The provider’s commissioning team carried out periodic reviews of the quality of the service. The provider had made progress towards completing a comprehensive improvement plan for the service.

Danesfield Supported Living Service provides care and support for 19 people in their own homes including 24 hour care. This includes care and support for people with a learning disability, mental health problems and physical disabilities.

The service did not have a registered manager at the time of our inspection. The registered manager had retired from the service following a period of long term sickness. A new manager had been appointed and had been in post for six weeks at the time of our inspection. The new manager had not yet applied to the Care Quality Commission to become the registered manager. 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. We received positive feedback from staff about the new manager. One staff member described the new manger as, “A very nice lady, approachable.”

People said they were happy with their care. One person commented, “They [staff] are always helpful.” People were treated with respect by staff who knew their needs and preferences well. One person said, “[Staff member] helps, [staff member] is a nice lady. She gives me a nice bath, helps me to choose my clothes.” People were supported to be as independent as possible. They accessed the local community, went on holidays and maintained contact with family members and friends.

People told us they felt safe and reassured living at the service. One person said, “I can talk to [three staff member’s names].” Another person said, “I could phone (staff) but I don’t like using the phone so I go and find them.”

Staff showed a good understanding of safeguarding adults and whistle blowing, including how to report concerns. One staff member said, “I have seen nothing at all [of concern]. The manager would deal with it straight away and investigate.” Safeguarding concerns had been reported correctly to the local authority safeguarding team and investigated.

The quality of some risk assessments was inconsistent and some lacked sufficient detail about how to manage identified risks. All risk assessments we viewed had been reviewed regularly to keep them up to date.

The registered provider had systems in place to check the premises and equipment were safe for people to use. This included portable appliance testing (PAT) checks, a fire risk assessment, a legionella risk assessment and an up to date electrical safety certificate. The registered provider also carried out weekly and monthly health and safety checks, including fire safety checks. Personal emergency evacuation plans (PEEPs) had not yet been written for people using the service.

Medicines were managed safely. Medicine administration records (MARs) had been completed accurately to confirm which medicines had been administered. Errors in records had been corrected with an explanation recorded as to what action had been taken. People had detailed and up to date medicines support plans.

There were enough appropriately recruited staff to meet people’s needs in a timely manner. One person told us, “There are enough staff to look after me.” Staff also confirmed there were enough staff.

Accidents and incidents were recorded with details of any action taken to deal with the issue.

Most staff training was up to date. A plan had been developed to ensure any overdue training was completed. Although all staff had met with the new manager for a one to one supervision recently, they had not had regular supervision prior to this. Appraisals for 2015 were not up to date but there was still time to have these completed by the end of March 2016 to meet the registered provider’s expectations.

Staff understood their role in supporting people with decision making, including when the Mental Capacity Act (MCA) applied to a person. Advocates were used regularly to support people with making specific decisions. We did not see within people’s care records evidence of recorded MCA assessments and best interest decisions having been completed. We have made a recommendation about this.

People had access to a range of health professionals when required, including dentists, GPs, community nurses, podiatrists and specialist nurses. One person said, “The doctor comes to see me in the flat.”

People were supported to meet their nutritional needs, including where people had special dietary needs. One person said, “Staff come in to help me with dinner.” Another person said, “I go shopping for food at [supermarket name]. I have support to do shopping.”

People had their needs assessed which included staff gathering information about people’s care needs and preferences. Personalised, up to date care plans were in place to guide staff as to how people wanted their care provided.

A range of activities were available for people to take part in. One person said, “I go to the disco on a Tuesday. I sing at the disco. I go to the club. I do different things, making a snowman for the Christmas tree.” One staff member said, “Every day is different. Staff stay to support residents at the Excel club [a local day centre]. They do crafts such as sewing and games.”

People knew how to raise concerns if they were unhappy, although people we spoke with said they did not have any concerns about their care. One person said, “I would talk to [staff member] if there was something I was concerned about. I am very happy here.” Another person commented, “If I have a problem I can talk to [staff member] it would be sorted.” There had been no complaints received since April 2014.

People could give their views about the service through attending regular meetings. One person said, “I attend meetings to talk about what we want to do. I went to one two or three weeks ago.” Another person said, “I attend meetings to decide on activities.” People were also sent questionnaires to fill in with their views. Feedback from the most recent consultation was positive about people receiving the right support.

There was good communication within the service. The new manager had been pro-active in sending out memos to staff about changes to procedures. Staff completed a communication book to share important information. Staff members had the opportunity to attend staff meetings. One staff member commented, “There are regular staff meetings and an open door policy.”

The registered provider had internal and external checks in place to check on the quality of the care provided. These included weekly and monthly checks of fire safety, people’s finances and the quality of care plans and risk assessments. A specific check of medicines was also carried out regularly. Some of these checks had not been carried out in October or November 2015. The registered provider’s commissioning team also checked on the quality of people’s care. We saw actions identified during the most recent review in October 2015 had been completed.

We saw there were effective recruitment and selection processes on staff. The provider followed the correct procedures regarding the risk of infection.

The provider had some systems in place to monitor the quality of service provided however people were not protected from the risks of unsafe or inappropriate care and treatment as personal records were sometimes not accurate or fit for purpose and audits failed to recognise this.