Housing 21 - Alice Bye Court

Housing 21 Alice Bye Court is a service which provides support to people living in specialist ‘extra care’ housing. People using the service lived in flats situated within one large building. At the time of this inspection 20 people were receiving personal care. Not everyone using the service receives personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. Whilst the service does not provide care and support to everyone living at Housing 21 Alice Bye Court, staff respond to all the residents if they activate their personal pendant alarms seeking assistance.

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

The safe management of people’s prescribed medicines had significantly improved, particularly in relation to their high-risk and night- time medicines, which made people feel safe. The provider needed time to demonstrate the required improvements made had become embedded and sustained.

People experienced safe care, protected from avoidable harm by staff who had completed safeguarding training and knew how to recognise and report different types of abuse. Staff assessed risks to people, which were managed safely. Enough staff with the right mix of skills and knowledge, delivered care and support to meet people’s needs, in line with their risk assessments and support plans. Staff underwent a robust recruitment process which explored gaps in their employment history and conduct in previous care roles, to assure their suitability to support people living in their own homes. Staff demonstrated high standards of hygiene and cleanliness whilst delivering care and support.

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.

The management team led by example and promoted a person-centred culture where people and staff felt valued. The registered manager understood their responsibilities to inform people when things went wrong and the importance of conducting thorough investigations to identify lessons learnt to prevent reoccurrences. The registered manager effectively operated the provider’s governance framework to ensure robust to monitoring of care quality, safety and the experience of people within the service. Quality assurance was embedded within the culture and running of the service, to drive continuous improvement. Staff collaborated closely with community professionals to ensure people received appropriate care and treatment to meet their changing needs. Staff supported people to make choices and worked effectively with other partners, to ensure specialist or adaptive equipment was made available to enable improved care and support.

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 5 March 2021) 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 improvements had been made and the provider was no longer in breach of regulations.

We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.

Why we inspected

We carried out an announced inspection of this service on 27 January 2021. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment (Regulation 12) and good governance (Regulation 17).

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 comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 Housing 21 Alice Bye Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Housing 21 Alice Bye Court is a service which provides care and support to people living in specialist ‘extra care’ housing. People using the service lived in flats situated within one large building. Currently, the service provides care and support to 27 people. Not everyone using the service receives personal care. Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. Whilst the service does not provide care and support to everyone living at Housing 21 Alice Bye Court, staff respond to all the residents if they activate their personal pendant alarms seeking assistance.

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

The service management and leadership was inconsistent and did not always support the delivery of high-quality, person-centred care. Deficiencies identified during our last inspection had not been fully addressed and the provider had not effectively operated processes to ensure compliance with regulations. The management team did not always effectively operate quality assurance and governance systems to drive continuous improvement in the service. The management team had not promoted a person-centred, inclusive service which empowered staff to deliver good outcomes for people. Staff consistently told us they did not feel that the management team listened to them and had lost confidence in their capability to address concerns effectively.

People were at risk of harm because staff had not always administered medicines safely and people had not consistently received their medicines as prescribed. The provider had implemented a new policy and procedures to ensure medicines were managed safely and had appointed a medicine’s champion. However, staff were not consistently following the new procedures. The provider had improved their reporting of medicine errors, which were now open and transparent. However, a high level of medicine errors continued to be made.

Staff had completed safeguarding and whistleblowing training and consistently understood how to report concerns when required. People experienced care from staff who were aware of people’s individual risks. The registered manager completed a regular needs analysis based on people’s dependency to inform the required staffing level to meet people’s needs. There were enough suitable staff deployed to support people to stay safe and meet their needs. People had their assessed needs, preferences and choices met by staff with the right qualifications, skills, knowledge and experience. Staff had completed an induction process and did not work unsupervised until they were confident and assessed to be competent to do so. The provider was preventing visitors from catching and spreading infections, promoting safety through adapting the layout and hygiene practices within premises.

People were supported to have maximum choice and control of their lives and staff did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager understood and complied with their duty of candour, to be open and honest when things went wrong. The registered manager had collaborated effectively with health care professionals to support people with mental health needs.

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 2 March 2020) and there were two breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 27 November 2019. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they now met legal requirements. In addition, we had received concerns in relation to the management and safety of the service provided. For these reasons this report only covers our findings in relation to the key questions of safe and well-led, which cover those requirements and concerns.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Housing 21 – Alice Bye Court 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.

We have identified breaches in relation to the safe care and treatment of people and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Housing 21 Alice Bye Court is a domiciliary care agency. This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. Alice Bye Court contains 51 flats on one purpose-built site. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing, this inspection looked at people’s personal care and support. Not everyone using the service receives personal care. For example, not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of inspection, the service was providing care and support to 32 people.

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

People had been exposed to the risks associated with the unsafe management of medicines. Staff had not consistently administered medicines safely and people had not always received their medicines as prescribed. Staff had not consistently followed the provider’s policies and procedures to ensure medicines were managed safely, in accordance with current guidance and regulations.

Governance and performance management was not always reliable and effective and quality assurance was not always applied consistently. People’s developing risks were not always managed safely. The provider had recently created an action plan to drive improvement in the management of incidents to safeguard people. However, the management team had failed to always effectively analyse incidents and put measures in place to prevent future occurrences. This meant people were exposed to further potential risk of harm because immediate action was not always taken to mitigate risks.

Support for staff from the management team was inconsistent. There were low levels of staff satisfaction and a lack of confidence in the management team, with most staff feeling they were not listened to, valued or respected.

Equality and diversity were not consistently addressed by the management team, which had led staff to feel they were not always treated fairly.

The provider had completed thorough pre-employment checks to make sure staff had the appropriate skills and character to support vulnerable people in their own homes. The manager ensured enough staff were deployed, with the right mix of skills to deliver care and support to meet people’s needs safely. The service did not use agency staff. Staff adhered to the provider’s infection control policy and used the appropriate equipment and clothing, whenever required. Staff had completed food safety training and correct procedures were followed wherever food was prepared.

Staff had the necessary skills and knowledge to meet people’s needs. The registered manager operated a system of training, supervision, appraisal and competency assessments, which enabled staff to provide good quality care. Staff promoted people's health by supporting people to access health care services when required and by encouraging people to eat a healthy diet.

People were supported to have maximum choice and control of their lives and staff supported /did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported/ did not support this practice.

Staff effectively involved people in decisions about their care, which ensured their human rights were upheld.

Staff consistently treated people with kindness and respect. People were supported to express their views about their care and their wishes were respected. People's privacy and dignity were respected and promoted during the delivery of their care.

People received personalised care that was responsive to their individual needs and preferences. Staff enabled people to raise concerns and complaints, which were used to improve people's experience of the care they received. The service was not supporting anyone with end of life care. However, people had the opportunity to discuss their wishes and preferences in this regard, which were reviewed regularly.

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

Rating at last inspection

This service was registered with us on 10/12/2018 and this is the first inspection. The last rating for this service was requires improvement (report published 14 July 2018). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement

We have identified breaches in relation to the unsafe management of medicines and poor governance of the service to ensure compliance with the regulations.

You can see what action we have asked the provider to take at the end of this full report.