Archived: Underhay House

Updated 5 January 2019

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.

This inspection took place on 11 and 17 December 2018 and was unannounced. One inspector carried out the inspection. The previous inspection was completed on the 28 and 29 November 2017 when the service was rated overall as requires improvement.

Before the inspection, we asked the provider to complete 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 reviewed information we held about the service, including the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales. Before the inspection, we contacted six health and social care professionals and received feedback from four of them. Their comments are included in the main body of our report.

We spoke with four people who used the service and spent time with other people. This was because some people were unable to tell us about their experience of living at Underhay House. We spoke with the registered manager, a senior manager and three members of staff.

We looked at the care records for three people who used the service and other associated documentation. We also looked at records relating to the running of the service. This included staffing rotas, policies and procedures, quality checks that had been completed, supervision and training information for all staff.

Updated 5 January 2019

The inspection was carried out by one inspector on the 11 and 17 December 2018.

Underhay House provides accommodation and personal care for 12 people. There were nine people living in the home at the time of the inspection. People who live at the home have a learning disability. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.

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 service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

At our last inspection in 2017 we rated the service as requires improvement. This was because some improvements were required to the environment to ensure it was safe and meeting the needs of people. Some areas of the home were not clean and carpets and furniture were stained. There was not always sufficient staff with the right skills who received regular supervision or support. Staff were not following the guidelines set down by professionals, which meant a person might be of risk of choking. Training focused on mandatory training rather than the health and social care needs of people, which meant there was a risk of people not receiving effective and consistent care that was based on current best practice. Checks were not being consistently completed on the quality provided to people.

The provider sent us an action plan after the last inspection. What they told us they would do had been completed to address the breaches in regulation.

People now received a safe service. Staff ensured that people got on well. Risks had been assessed and safe systems of work were in place to ensure people’s safety whilst not curtailing their independence. Staff had been through a thorough recruitment process to ensure they were suitable to work at Underhay House. Safe systems were in place to ensure that people received their medicines as prescribed.

People were receiving care that was responsive and effective and tailored to their needs. Care plans were in place that clearly described how each person would like to be supported. People had been consulted about their care and support. The care plans provided staff with information to support the person effectively. Other health and social professionals were involved in the care of the people and there was very much joint working with them and family. Improvements were needed to ensure the recording of care was consistent. An action plan was in place including further training for staff on report writing.

People were supported by suitable numbers of staff, with the right skills and knowledge. Staff had received training and were supported in their roles. They regularly received supervision and team meetings were organised monthly. This area had improved since the last inspection.

People were valued and supported to be as independent as possible. People’s rights were upheld, consent was always sought before any support was given. Staff were aware of the legislation that ensured people were protected in respect of decision making and any restrictions and how this impacted on their day to day roles.

People were provided with nutritious food and drink, which met their dietary preferences and requirements. People were supported to eat a healthy diet of their choice.

People were provided with a safe, effective and caring service that was well led. There were some improvements needed to ensure the service was responsive. There was an action plan in place.

The organisation’s values and philosophy were clearly explained to staff and there was a positive culture where people were included and their views sought. The registered provider was aware of the importance of reviewing the quality of the service and was aware of the improvements that were needed to enhance the service.