Archived: Cricklade Road

At a comprehensive inspection in December 2015 the overall rating was Inadequate and the service was placed into special measures by the Care Quality Commission (CQC). Four breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We found significant risks to people due to the management of medicines. We also found risks to people’s environment that meant people were not protected in the event of a fire. People and staff did not have relevant risk assessments in place to ensure their safety. People in the service did not receive care and support that was individualised to their needs. Following our previous inspections we had concerns with the general leadership and management of the home. A management team had been put in place to oversee the day to day running of the home until the appointment of a registered manager. Following the inspection, we received regular action plans which set out what actions were to be taken to bring the service up to standard.

We undertook another inspection on 4 May 2016 in line with our special measures guidance to see if improvements had been made. We could see that some action had been taken to improve people’s safety but further improvements were needed to ensure people were safe. For example, risk assessments had not been completed for people that self-medicated and not all actions had been completed to improve fire safety. Staff had not undergone lone working risk assessments and were not receiving regular supervision to support them. Complaints had not been processed in line with the complaints policy. Systems and processes in place to ensure the regulations were met had not identified the issues we found in the inspection and therefore were not effective in keeping people safe. There were continued breaches in Regulation 9, Regulation 12 and Regulation 17 with an overall rating of Inadequate. Therefore, the service remained in special measures meaning significant improvements were required, or further enforcement action could be taken. Following this inspection we asked the provider to submit monthly actions plans.

At this inspection on 3 November 2016, we found considerable improvements in the service. The environment had improved noticeably and health and safety audits meant any issues that may cause concern were picked up on swiftly and actioned. The management of medication had improved, although there were some areas to improve upon. We have made a recommendation about the management of some medicines.

Staff had received appropriate training to support them in their roles and staff told us they felt well supported.

We observed pleasant and friendly interactions between staff and people who used the service. The people with whom we spoke told us they were happy with the care they received

People had care plans in place which were person centred and provided relevant guidance for staff about how to care for and support people. These were reviewed at regular intervals and updated where necessary. We found that people were receiving support that was relevant to their circumstances and person centred to identify achievable goals to help them towards independent living. Activities had been discussed and were offered regularly to people in the service.

We found there were effective systems in place to monitor the quality of the service provided and regular checks were undertaken in all aspects of running the home. Commissioners had reported improvements in the service.

Cricklade Road is a care home run by the National Schizophrenia Fellowship, also known as Rethink Mental Illness, where up to six people who are experiencing a mental health crisis can stay. The aim of the service is to help people move on to more independent accommodation by providing support that meets their changing needs. At the time of inspection there were four people living at the home.

The service has a registered manager, but they were not present during this inspection. 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. An interim manager was covering the registered manager’s absence and was present during the inspection.

At a comprehensive inspection in December 2015 the overall rating was Inadequate and the service was placed into special measures by the Care Quality Commission (CQC). Four breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We found significant risks to people due to the management of medicines. We also found risks to people’s environment that meant people were not protected in the event of a fire.

People and staff did not have relevant risk assessments in place to ensure their safety. People in the service did not receive care and support that was individualised to their needs. There were also concerns relating to the management and leadership of the service. Following the inspection, we received an action plan which set out what actions were to be taken to meet the requirements of the regulations.

During our inspection on 4 May 2016, we looked to see if improvements had been made. We could see that some action had been taken to improve people’s safety but further improvements were needed to ensure people were safe. An issue raised at the last inspection relating to people not having risk assessments in place where the person was managing their own medicines had not been addressed.

There were no staff risk assessments in relation to lone working on staff files. We were told these had been completed but they were not available for us to see. We found risks to people’s environment to improve fire safety had been improved but further improvement was needed to meet the actions the service had said it would take after the last inspection. Safety checks on gas and electric and water temperatures had taken place.

Staff had training on keeping people safe and understood the process of reporting concerns. Staff had been checked to ensure they were suitable before starting work in the service.

People were still not receiving support in a person centred way. People were not always supported to identify and achieve personal goals. Where people had identified activities they wished to participate in they had not been supported to do so.

Staffing levels had not increased but permanent staff were employed by the service. This meant reliance on agency staff had reduced. Training had been booked to improve person centred approaches. Staff said they felt supported but not all staff were having regular supervision.

Staff had an understanding of the Mental Capacity Act 2005 and had received refresher training since the last inspection. However, we saw no evidence of capacity being assessed in relation to people keeping themselves safe around certain risks which could affect them and others in the service.

People had an opportunity to discuss what food they wanted and staff helped to ensure healthy food was prepared for people’s meals.

People were supported to access health professionals or appointments. However, support to people who needed prompting about appointments had not always happened. There was an ongoing need to ensure the service and health professionals worked jointly in a timely way to improve the support required for people’s recovery.

Staff had attended regular team meetings to enable them to raise concerns and discuss issues collectively.

Staff spoke with warmth and care about the people in the service they supported and made an effort to get to know them well.

Complaints had not always been evidenced as resolved.

The service had not ensured that the systems and processes in place to assess and monitor the service were of good quality and met regulations. Audits that had taken place since the last inspection had not identified the ongoing issues found in this inspection.

The service was working with commissioners to ensure that clear outcomes for individuals in the service were identified and worked towards.

We found the registered provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and rated as inadequate in responsive and well led. This means the overall rating for this service is ‘Inadequate’ and the service therefore remains 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, talking with three people using the service, two staff members and the manager. We reviewed the care plans of the five people who lived in the home and other relevant records. This was the first inspection of this service which was registered in December 2013.

Is the service safe?

Care plans were detailed and instructed staff how to meet people's needs in a way which minimised risk for the individual. They ensured that staff members had all the information necessary to support people in as safe a way as possible.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Training records showed that relevant staff had been trained in the Mental Capacity Act 2005 which incorporated DoLS. The type of care the home provided and the needs of the people who lived there meant that it had never been necessary to deprive people of their liberty.

Staff were trained in the safeguarding of adults and fully understood their responsibilities with regard to keeping people who lived in the home safe.

The home made sure that staff were well trained and well supported to enable them to provide safe care to the people who lived there.

Systems were in place to make sure that the manager and staff continually monitored the quality and safety of care offered to people.

Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to the people who lived in the home, staff and visitors.

The people we spoke with told us they felt safe in the home.

Is the service effective?

People's health and care needs were assessed with them and they were helped to make informed decisions about their lifestyle and recovery plan. Care plans were detailed and clearly identified people's needs and how they should be met. We saw that staff gave support as described in individual's care plans.

We saw that people signed behavioural agreements as part of their recovery plans and accommodation agreements.

We saw that the home worked closely with other services to make sure that people were supported with their physical and mental health and behavioural needs.

People said about the home and care: 'it's all good'.

Is the service caring?

People were supported by caring, knowledgeable and patient staff. We saw that care staff were encouraging and positive. Staff communicated and interacted with people at all times.

People's diversity, values and human rights were respected. Care plans were individualised and person ' centred. We saw that people were treated with respect and dignity by the staff. People were given information about what to do if they felt their privacy or dignity had been compromised in any way.

Is the service responsive?

Care plans were reviewed regularly and amended, as necessary, to meet people's current needs. People were fully involved in making any changes. We noted that staff worked hard to support people to achieve an enjoyable and rewarding life. However, ultimately people made their own choices about their lifestyle. We saw that people were supported and encouraged to access health services in a timely way.

The home had made changes and improvements as a result of ideas and discussions with people who lived in the home.

The home had made the changes recommended by the local authority commissioning team.

The home had not received any complaints in 2014.

Is the service well led?

Staff members told us that they felt very well supported to do their job. They said that they worked in a very strong and committed team and they were all valued and their views were listened to.

The service had a formal quality assurance system. We saw records which showed that the home identified shortfalls and the actions to be taken to address them. As a result the quality of the service was being maintained or improved.