We carried out an unannounced comprehensive inspection of this service on 8 July 2014. Several breaches of legal requirements were found. As a result we undertook a focused inspection on 4 November 2014 to follow up on whether action had been taken to deal with the most significant breaches.
You can read a summary of our findings from both inspections below.
Comprehensive Inspection of 8 July 2014
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, and to provide a rating for the service under the Care Act 2014.
This was an unannounced inspection. At the last inspection carried out on 4 March 2014 we found that the provider was not meeting the regulation in relation to medicines as there were not appropriate arrangements in place for the safe storage, administration and disposal of medicines. Following the inspection the provider sent us an action plan telling us about the improvements they were going to make. During this inspection we found that the provider had not taken action to address these issues. We have taken action against the provider and issued a warning notice about the unsafe management of medicines.
Sidney Avenue Lodge Residential Care Home provides care and support for eight men who have learning disabilities and also have a mental health diagnosis. There were eight people living at the service at the time of our inspection. It is a family run business and four family members were working at the home, one of whom was the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
People were not kept safe at the home. There were poor arrangements for the management of medicines that put people at risk of harm, staff were unable to demonstrate they knew how to identify or respond to abuse and the recruitment checks for new staff were not complete.
We found that there were restrictions imposed on people that did not consider their ability to make individual decisions for themselves as required under the Mental Capacity Act (2005) Code of Practice.
Although people’s needs had been assessed and care plans developed these did not always adequately guide staff so that they could meet people’s needs effectively. Also, potential health concerns such as significant weight loss were not always identified which could result in people’s healthcare needs not being met.
Staff were not provided with sufficient supervision and training to ensure they were able to meet people’s needs effectively but they were given an induction to the service so that they knew what people’s needs were.
Staff did not always respect people’s privacy and standard restrictions were unnecessarily applied to everyone using the service. For example, people were at times restricted from making themselves snacks and drinks which meant their independence was not always promoted.
The provider was not adequately monitoring the quality of the service and therefore not effectively checking the care and welfare of people using the service. In addition to this the provider had failed to provide information requested by the Care Quality Commission about the service.
People told us they were cared for by staff and we saw that people were involved in the recruitment of new staff and planning social events at the home. They told us they enjoyed the food and were supported to maintain relationships with family and friends. We observed caring interactions between staff and people using the service and saw that people were encouraged to access local amenities and take part in leisure activities.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
Focused inspection of 4 November 2014
After our inspection of 8 July 2014 the provider wrote to us to say what they would do to meet legal requirements for the breaches we found. We undertook this unannounced focused inspection to check that the most significant breaches of legal requirements, concerning the management of medicines, which had resulted in enforcement action, had been addressed. We checked to see that the provider had followed their plan and to confirm that they now met legal requirements. We found that the provider had followed their plan in relation to this regulation. This means legal requirements for the management of medicines had been met.
A system for auditing the management of medicines had been implemented to check whether medicines were being administered safely and as prescribed. Medicines were stored safely. Medicines policies had been updated. A risk assessment was now in place for a person who wanted to self-administer their medicines. Care plans were in place for people prescribed medicines for challenging behaviour. Staff managing medicines for people had received medicines training, and staff without recent medicines training did not administer medicines unsupervised.
We found that there were some issues with the recording of medicines. We were provided with evidence following the visit that medicines records were now completed fully and that systems were now in place to manage medicines safely, to protect people using the service against the risks associated with the unsafe use and management of medicines.
We will undertake another unannounced inspection to check on all other outstanding legal breaches identified for this service.