Archived: Auckland House

Auckland House is a residential care home for people living with a learning disability,

autistic spectrum disorder or mental health need. The service was a large home, bigger than most domestic style properties. The care home is registered to accommodate 8 people. There were 8 people living at Auckland House at the time of the inspection. The building design fitting into the residential area and the other large domestic homes of a similar size.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Based on our review of the safe and well-led key questions the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

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

Right Care: People were at risk of harm because staff did not always have the information, they needed to support people safely. Medicines were not managed safely.

People did not receive consistent person-centred care that was empowering, of a high-quality and achieved good outcomes. Improvements were needed.

People had privacy for themselves and their visitors. The service was located so people could participate in the local community.

Right Culture: Ethos, values, attitudes and behaviours of leaders and care staff did not fully ensure people using services led confident, inclusive and empowered lives.

Leadership was poor, and the service was not always well-led. Governance systems were ineffective and did not identify the risks to the health, safety and well-being of people or actions for continuous improvements.

The provider did not have enough oversight of the service to ensure that it was being managed safely and that quality was maintained. Quality assurance processes had not identified all the concerns in the service and where they had, enough improvement had not taken place. Records were not always complete. People and stakeholders were not always given the opportunity to feedback about care or the wider service. This meant people did not always receive high-quality care.

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

Rating at last inspection

The last rating for this service was requires improvement (published 1 August 2019).

At our last inspection we recommended that the provider sought current guidance on the application of the Mental Capacity Act and medicines management. At this inspection we found the provider had not acted on these recommendations and improvements were still required.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement and Recommendations

We have identified breaches in relation to risk management, medicines management, managing infection control, following the principles of the mental capacity act, recruitment of staff, good governance, failure to notify CQC of significant events and person-centred care at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

People’s experience of using this service:

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; people’s abilities, needs and mental capacity were not always assessed to ensure they had as much choice and control as possible. We have made a recommendation about the management of some medicines, reviewing current guidance and the application of the Mental Capacity Act (2005).

People told us they were safe at the service. Risk management required improvement to ensure risks to people had been identified and assessed. The Mental Capacity Act (2005) had not always been applied to decision making where appropriate.

Person centred care was promoted in the service and people experienced positive outcomes, however people’s support plans did not always reflect all their needs and goals to support the delivery of person centred care.

Quality assurance processes were in place but had not identified some of the concerns we found. The registered manager took prompt action to address these shortfalls and ensure actions for improvement were added to their action plan for the service.

There was a positive culture in the service and staff were supported through training, supervision and team meeting to provide effective care for people. People told us staff were kind and caring and were treated with dignity and respect.

Rating at last inspection: This service was rated Good at the last inspection and the report was published on 21 October 2016.

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

Follow up: We will follow up on our recommendations at the next scheduled inspection. We will continue to monitor the service through the information we receive.

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

Auckland House provides care and accommodation for up to eight people. On the day of the

inspection eight people were living in the home. The service provides care for people with a learning

disability.

The manager had undertaken their interview with the Commission in August 2016 to be the registered manager, and they have been advised their certificate will be issued shortly. 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.

Following an inspection in July 2015 we asked the provider to take action to make improvements which related to records, notifications and quality assurance. At this inspection, we found the necessary improvements had been made.

The service provided good care and support to people allowing them to lead fulfilled and meaningful lives. The interactions between people and staff were positive. We heard and saw people laughing and smiling. People looked comfortable, relaxed and happy in their home and with the people they lived with. Relatives were welcomed into the home and had clearly formed positive and trusting relationships with the staff team.

There was a positive culture within the service. The manager said, “As well as being the manager I like to work with people. I enjoy spending time with the staff and people we support”. Staff had a good understanding of people’s needs and spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people’s needs and to keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe. Staff were trained and aspects of training were used regularly when planning care and supporting people with their needs and lifestyle choices.

People were supported by staff who had a good understanding of how to keep them safe. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm.

Staff encouraged people to be independent and promoted people’s choice and freedom. People moved freely around the building and its grounds and the community as they chose.

Care records contained detailed personalised information about how individuals wished to be supported. People’s individual methods of communication were taken into account and respected. People’s risks were well managed, monitored and regularly reviewed to help keep them safe.

People were supported to take part in a range of activities both inside and outside in the community.

People had their medicines managed safely. People were supported to maintain good health through regular access to health and social care professionals, such as GPs and speech and language therapists. People’s dietary needs and any risks were understood and met by the staff team.

The manager and staff demonstrated a good understanding of the Mental Capacity Act 2005. People were supported to make everyday choices such as what they wanted to eat and how to spend their time. The manager was aware of the correct procedures to follow when people did not have the capacity to make decisions for themselves and if safeguards were required, which could restrict them of their freedom and liberty.

The manager was aware that notifications about important events to CQC had not always been made and since joining the home in December 2015 had been making notifications when needed. The manager had just become aware of DoLS requests having been made in 2015 and agreed to notify CQC as soon as possible.

Staff described the management as supportive and approachable. Staff talked positively about their work and comments included, “It’s a good place to work, the team are committed to meeting the needs of the people who live here”. Staff were well supported through induction and ongoing training.

The service had an open door policy. People’s relatives opinions were sought through surveys and there were effective quality assurance systems in place that monitored people’s satisfaction with the service. Timely audits were carried out and investigations following incidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the service.

We used this visit to answer our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

Three of the people we spoke with had no concerns about the support they received. People and their relatives told us about their satisfaction with the home and told us they felt safe. A relative told us, 'They care for my relative; even when they are challenging. I have no worries about their safety.' We saw that care and treatment was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had assessment tools in place to assist staff in establishing the level of risk for people.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us staff had received training with regard to DoLS; and the home was working with the local learning disabilities team on a DoLS application for one person. We saw there were suitable arrangements to ensure people were protected from the risk of abuse.

There were arrangements in place to deal with foreseeable emergencies. The service had a business contingency plan to deal with any short or long term emergencies such as loss of electrical power or loss of gas supply. The home was working on a contingency plan should the home become uninhabitable and people could not return to the home after an evacuation.

Is the service effective?

Each person had a plan of care and support; these explained what the person could do for themselves and what support they needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We observed staff supporting people. The care staff we spoke with were aware of people's needs and people's preference in how they wanted their care to be delivered. We saw staff offer advice and support and enabling people to make their own choices and decisions.

Is the service caring ?

We saw people being treated kindly and with dignity and respect by the registered manager and staff. Care workers spent time chatting with people and responded promptly to people's request for assistance. Staff had a good understanding of people's needs. People described their satisfaction with the home. One person told us, "I like it here. The staff are brilliant.' Another person told us, 'Staff are always nice and polite ' Everybody gets treated the same way.'

We heard staff speaking to people appropriately and staff using people's preferred form of address. Most of the people we spoke with told us the staff' were kind and patient in their approach.

Is the service responsive?

Staff responded promptly to peoples request for assistance. People had regular reviews of the care and support they received and care plans showed alterations had been made to people's plans of care as people's needs had changed. We saw people were able to participate in a range of activities. Staff told us they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service, their relatives, and staff were asked for their views about how the home was meeting people's needs and any concerns or ways to improve the service were acted on.

Is the service well led?

A relative we spoke with told us they had regular contact with the home and said they could speak to the manager or staff at any time. They told us they were kept informed about any issues which affected their relatives.

All of the staff and people we spoke with said they felt supported. We saw the home had systems to monitor and assess the quality of the service provided by the home. These included the service manager conducting a number of monthly audits including health and safety inspections of the property, people's care records, and staff training and supervision.

Staff meetings took place monthly and minutes of these meetings were kept. Staff we spoke with confirmed this and said the staff meetings enabled them to discuss issues openly with the manager and the rest of the staff team.

On the day of our visit the registered manager was not available and we were supported by a senior member of the care staff who was able to provide us with good information about the service provided at Auckland House.

We also spoke with three members of staff. They said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were supportive and approachable.

People we spoke with told us they were happy at the home and that staff treated them well. They said that they felt safe at the home and if they had any concerns they would speak with a member of staff.

We also spoke with two relatives of people who told us that they were very happy with the care and support their relatives received. They said that they were consulted about the care and support their relative received and were invited to reviews of their relative's care. Comments included: 'The staff always keep me informed of any changes and my relative is happy at Auckland House'.

Relatives told us that they knew how to make a complaint and said they were confident that any complaints would be dealt with appropriately.

We spoke with three members of staff. They said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively.