Background to this inspection
Updated
10 July 2018
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 17 and 20 May 2018 and was unannounced. This inspection was conducted by one inspector, a specialist advisor, whose specialism was nursing and an expert by experience (ExE). An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection, the provider completed 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 looked at previous inspection reports and notifications received from the provider. A notification is information about important events which the provider is required to tell us about by law. This ensured we were addressing any areas of concern.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We spoke with four people, five relatives, four care staff, two nurses, the activity coordinator, The physiotherapist and the manager. We looked at eight people’s care records, five staff files and medicine administration records. We also looked at a range of records relating to the management of the service.
Updated
10 July 2018
John Masefield House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. John Masefield House is run by Leonard Cheshire Disability. The home provides support and nursing care for up to 22 physically disabled adults. The home has large communal living areas in the lounges, dining room and activities area. There are extensive gardens which are accessible to the people living in the home.
At our last inspection on 19, 20 and 22 September 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014). These related to risks to people not being managed safely. People were not protected against the risk associated with choking and aspiration and pressure damage. Medicines were not always stored securely. People were not always supported in line with the principles of the Mental Capacity Act 2005 (MCA). People at a risk of malnutrition were not always supported appropriately. Staff did not always follow recommendations and guidance from healthcare professionals. Records relating to people’s care were not always up to date or accurate, The provider did not have effective systems in place to monitor the quality of service. As a result of our findings we took enforcement action and issued a warning notice.
We also found one breach of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations (2014). The registered manager had not always notified CQC of reportable events. Services that provide health and social care to people are required to inform CQC of important events that happen in the service.
At this inspection we found the service had made significant improvements to address these concerns.
Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people's needs and followed guidance to keep them safe. People received their medicines as prescribed. Records confirmed where people needed support with their medicines, they were supported by staff that had been appropriately trained.
The manager and staff understood the MCA and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.
Records relating to people’s care were accurate and complete. The service was embedding systems to assess the quality of the service provided. The manager and provider was able to identify how these new systems would support them in identifying and learning from the audits it would produce. This would promote people's safety and quality of life.
Staff spoke positively about the support they received from the manager. Staff had access to effective supervision. People told us and staffing rotas confirmed there were sufficient staff to meet people's needs. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.
People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with the staff who had a caring approach to their work. People’s views, opinions and feedback were sought prior to changes within the service.
People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.
There was not 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 told us they were safe. Staff understood their responsibilities to identify and report all concerns in relation to safeguarding people from abuse. Staff had completed safeguarding training.
There was a complaints policy and procedure in place which had recently been reviewed. Details of how to complain were kept in people’s rooms and people had been informed of the new policy and procedures
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This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
The service now has an overall rating of requires improvement. This is because we need to be satisfied that changes are being sustained.