Archived: Health and Home Ltd - North Road

Health and Home Ltd - North Road is registered to provide accommodation and personal care for up to a maximum of 9 people. The service is set over two floors, with a small paved garden area to the rear of the property. On the day of our inspection, there were 5 people living at the service who required support with their physical and mental health needs.

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

People told us they were happy living at the service but found they were often bored and looked forward to being able to go out again in the community when lockdown eased.

The provider did not have robust processes in place to check staff’s suitability before commencing employment.

Governance processes were not consistent, and we could not be sure the provider had oversight of the service or followed regulatory processes.

Staff knew how to safeguard people and raise concerns; however, the provider did not follow the correct processes to report safeguarding concerns.

There were systems in place to manage infection control and staff were following government guidance.

Risk assessments and care plans were individual and supported people’s needs. Medicines was managed safely.

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

Rating at last inspection: The rating at the last inspection was requires improvement report published 17 October 2019. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected: This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the relevant key question for safe and well led sections of this full report.

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.

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 Health and Home Limited North Road 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to recruitment of staff and good governance at this inspection.

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.

Health and Home Ltd - North Road is registered to provide accommodation and personal care for up to a maximum of 9 people. The service is set over two floors, with a small paved garden area to the rear of the property. On the day of our inspection, there were 5 people living at the service who required support with their physical and mental health needs.

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

Feedback from people’s relatives about the service was very positive. This was summed up by one person's relative who told us, “I think the advantage is the service is so small so staff get to know everyone really well; its friendly and informal and feels like a family home; even when we arrive unannounced everything is clean and immaculate and well presented.”

Improvements had been made in the level of detail captured in people’s risk assessments and care plans to provide sufficient guidance for staff. New ways of working and quality assurance systems were being implemented but were not yet fully embedded in practice. Further improvements were still required in some areas including risk assessment and recording practices, auditing and embedding and sustaining the new systems and processes. Improvements were also required to the environment and in the oversight and management of Deprivation of Liberty Safeguard (DoLS) to ensure people were not being deprived of their liberty unlawfully.

People’s relatives told us they felt their family members were safe living at the service. People were supported by a regular staff team who had been safely recruited. People’s medicines were managed safely by staff who had been trained and assessed as competent. Staff received training in infection control and wore protective clothing to protect people from the risk of infection.

Staff received an induction, training and regular supervision and told us they felt well supported in their role. There was a schedule of refurbishment planned to improve the environment. People had access to food and drink which met their health needs and preferences. People were supported to access a range of health care services to maintain their health and wellbeing.

Staff were kind and caring and treated people with dignity and respect. People’s independence was supported and encouraged. Visitors were made welcome at the service and people were helped to maintain relationships that were important to them.

People’s care plans had been re-written to make them more person centred. Work was ongoing in exploring and documenting people’s personal life histories. People were supported by a long-standing and consistent staff team who knew people well.

There were systems in place to manage complaints. People and relatives knew how to make a complaint but told us they had never had to. Staff received training in end of life care. People’s end of life preferences were discussed and recorded.

The registered manager was aware of their role and responsibilities including duty of candour. Work was in progress to ensure this understanding extended to the whole of the staff team to ensure greater accountability at all levels. A plan for improvement across the service was in progress to ensure the required improvements could be made and sustained over time.

Rating at last inspection

In January 2019 we undertook a comprehensive inspection that looked at all key questions. We found multiple breaches of the regulations and the service was rated as Inadequate and placed in ‘special measures’. The final report was published on 8 March 2019. We returned in June 2019 to complete a further comprehensive inspection to review the service and found improvements had been made and the rating improved to Requires Improvement with continued breaches of Regulation 12 [safe care and treatment] and Regulation 17 [good governance]. This report has not yet been published.

After the previous two inspections the provider completed an action plan 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 however the overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

People’s experience of using this service:

The service did not demonstrate that they understood how to safeguard people from neglect and abuse. The registered manager had not always followed safeguarding protocols to ensure all reportable concerns were reported to the local authority.

Systems for supporting people after incidents had failed to monitor people's well-being. The provider did not always analyse accidents and incidents to identify themes and trends and prevent re-occurrences. There were limited lessons learnt processes to show how staff had learnt from events. This meant people were at risk of a repeat of incidents that exposed them to risk.

Staff had not carried out effective risk assessments to enable people to retain their independence and receive care with minimum risk to themselves or others. Risk assessments completed were not always accurate and a true reflection of people’s current care needs. We found that this process was being implemented but had yet to be embedded.

The current governance systems at the home were ineffective. The systems did not proactively monitor areas where the care delivered was not safe or meeting standards. Furthermore, arrangements in place did not ensure accountability and transparency. The registered manager lacked oversight and was not always aware of shortfalls and serious concerns in the home. New governance systems were in the process of being implemented but had not yet been embedded or seen to be effective.

The provider had an effective recruitment procedure, which ensured only suitable staff were employed in the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Our observations during the inspection, were of positive and warm interactions between staff and people who lived in the home. Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes.

Daily activities were provided, events were celebrated in the home and professional singers and entertainers were booked on a regular basis. People were aware of how they could raise a complaint or concern if they needed to and had access to a complaint’s procedure.

Rating at last inspection: The last rating for this service was Inadequate (published 08 March 2019). The service has now been rated as required improvement.

Why we inspected: Following the last inspection the service was placed under special measures. And therefore, meant we would be inspecting the service within six months as part of our ongoing monitoring of the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Health and Home Ltd – North Road on our website at www.cqc.org.uk.

Health and Home Ltd – North Road is a ‘care home’. 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 care home accommodates up to nine people who may be living with dementia or have enduring mental healthcare needs. At the time of the inspection, there were seven people living at Health and Home Ltd – North Road.

Health and Home Ltd – North Road is a large terraced house situated in a quiet residential area in Southend and close to all amenities. The premises are set out on two floors and there are adequate communal facilities available for people to make use of within the service.

The inspection was completed on the 10 January 2019 and was unannounced.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

A registered manager was in post and in addition to managing this service, they managed another of the provider’s ‘sister’ care home. 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.

Quality assurance checks and audits were not robust. These arrangements did not identify the issues we found during our inspection and had not recognised where people were placed at potential risk of harm and where their health and wellbeing was compromised. Complaints management required strengthening as information relating to the investigation, actions taken, outcomes and lessons learned were not recorded.

Although people’s comments about the care provided was positive, our findings at this inspection suggested the service was not always caring in its approach. Not all risks to people’s safety and wellbeing had been identified, and suitable control measures had not always been considered and put in place to mitigate the risk or potential risk of harm for people using the service. The service did not follow relevant national guidelines when giving people their medication and we found discrepancies relating to staff’s practice and medication records. Not all staff who administered medication had attained up-to-date training or had their competency assessed.

Risk management strategies and care planning arrangements were not robust and systems in place for upholding people’s rights to make sure they were supported in the least restrictive way possible were not adopted. There was a lack of information available to demonstrate people living at Health and Home Ltd – North Road were actively involved in making decisions about their care and support. There was a lack of evidence to demonstrate the use of physical restraint had been used in a safe and proportionate way. Not all safeguarding concerns or statutory notifications in line with regulatory requirements had been forwarded to the Local Authority or Care Quality Commission when they should have been. People were not routinely supported to be engaged in meaningful activities or supported to pursue pastimes that interested them.

Staff rosters indicated there were not always enough staff available to support people to stay safe. Newly employed staff had not received a robust induction, not all training had been updated and improvements were required to ensure supervision arrangements for staff were robust and effective.

Recruitment practices at the service were safe. Appropriate arrangements were in place to manage the control and prevention of infection within the service. People were supported where appropriate to be independent.

Health and Home – North Road is registered to provide accommodation and personal care without nursing for up to nine adults with a range of different needs. The service can cater for older people, people living with dementia, physical disability, sensory impairment, learning disabilities with autistic spectrum disorder, alcohol or drug misuse, eating disorders and mental health disorder. There were nine people living in the service on both days of our inspection visits.

There was a registered manager 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.

People received safe care and support. Staff had a good understanding of how to protect people from the risk of harm. The service had employed enough staff to meet people’s assessed needs. The recruitment process was thorough and ensured that staff were suitable to work with vulnerable people. People received their medication correctly as prescribed.

Staff were well trained and supported and had the knowledge and skills to carry out their role. They had access to guidance and information to support them when necessary. The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and had received training to ensure that where people lacked the capacity to make decisions they were protected. People were supported to maintain a healthy balanced diet and their healthcare needs had been met.

Staff were kind, caring and thoughtful and they knew the people they cared for well. They respected people and ensured that their privacy and dignity was always maintained. People expressed their views and opinions and were supported to follow their individual hobbies and interests. The service provided people with advocacy contact details for use if needed.

People’s care and support needs had been fully assessed and they had care plans and risk assessments in place to ensure that they were cared for in a way that they preferred. The care plans provided staff with the information that they needed to meet individual’s needs and preferences and to care for them safely. People were confident that their concerns or complaints would be listened to and acted upon. There was an effective system in place to assess and monitor the quality of the service and to drive improvements.