10 March 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
At the last comprehensive inspection of the home, carried out in July 2015, the home was rated as ‘Good’ with no breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. This latest inspection was carried out by one inspector on 5 and 8 January 2018.
Before the inspection we reviewed the information we held about the service. This included a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also liaised with local authority and health commissioners to obtain their views.
The registered manager and the management team assisted us throughout both days of the inspection. We spoke with two health care assistants, a care team leader and three visiting relatives. Following the inspection we contacted four health and social care professionals who gave us feedback on their view of the service. We also used the Short Observational Framework for Inspection (SOFI) as many of the people living at the home were not able to relate their experience of the home to us. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. In addition, we made general observations, including watching the delivery of care in communal areas.
We viewed two people’s care records in depth as well as sections of other people’s personal files. We reviewed everyone’s medicine administration records, three staff recruitment files, staff rotas and other records relating to training, supervision of staff and management of the service.
10 March 2018
Auckland Rest Home is a care home service that does not provide nursing care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to accommodate up to ten people and provides a specialist service for mainly older people living with dementia. The accommodation is domestic in scale and provides a homely environment for people, with access to a garden area.
The inspection was unannounced and took place on 5 and 8 January 2018. At the time of this inspection there were eight people living at the home.
There was a registered manager in post who has worked at the home for many years. 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.
Aucklands Care provides a small, highly effective service for people living with dementia. Part of the home’s success lay in the provider ensuring staff were trained to a high standard using a recognised dementia care training package that understands people's behaviours, including the way they communicate, as having meaning.
The provider also maintained staffing levels that allowed staff to devote time with people and provided good leadership that allowed this model of care to be delivered effectively. Staff had also been provided with specialist training in other conditions affected by people such as epilepsy and mental health to ensure people’s needs were met. The staff team were therefore able to deliver care in line with best practice.
Local commissioners viewed the home as a valuable resource as the service had provided placements with good outcomes for people whose care needs could not be met in other services.
Staff were kind, caring and compassionate in their interactions with people and very knowledgeable about their histories likes and dislikes. They were able to diffuse situations and divert people to better mood states through their interactions because of this very person centred approach to working with people.
People were kept safe as the provider had taken appropriate steps and had good systems in place to protect people. Staff had received training in safeguarding and people’s needs had been assessed with plans to mitigate risks that may be involved in the delivery of care. The premises had also been assessed and made as safe as possible for people. Accidents and incidents were recorded, monitored and action taken if necessary.
Staff were recruited in line with robust policies and all the necessary checks had been carried out.
There were good systems to make sure medicines were administered as prescribed.
People had an up to date comprehensive care plans in place so that staff could refer to these and deliver consistent care. The care we observed was consistent with people’s plans and they received a highly personalised service.
The service was compliant with the Mental Capacity Act 2005 (MCA). People were supported to make decisions. Where they did not have capacity for specific decisions, the home followed the requirements and principles of the MCA in arriving at ‘best interest’ decisions on their behalf. There were also robust systems to make sure that people were only deprived of their liberty in accordance with the Act, and that any conditions of that deprivation be applied.
Staff were supported though indirect and formal supervision as well as having access to on call managers. This is ensured staff were motivated, trained to a high standard and able to work effectively with people living at the home.
The home was highly effective in working collaboratively with health services and social care services in meeting people’s health needs.
The premises had been adapted with signage to facilitate better care of people living with dementia. The home was clean, in good decorative repair and provided a ‘homely’ environment. People were encouraged as far as possible to be involved in decoration of the home.
People were provided with a good standard of food with their having choice of what they wanted to eat and their individual needs catered for.
Activities and meaningful occupation were seen as being paramount in meeting the challenging needs of the people accommodated. Activities were therefore personalised to people’s interests.
Complaints were responded to and the procedure was well publicised.
Wishes and preferences for end of life care needs were assessed and plans put in place to meet these. Staff were trained in end of life care and one of the senior staff had delegated role as a champion.
The management team provided leadership and promoted a positive open culture.
There were auditing and monitoring systems being followed seeking overall improvement.