Background to this inspection
Updated
13 July 2016
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 23 May 2016 and was announced. The service was given 24 hours notice because the location is a small respite service and we needed to be sure that someone would be there when we arrived. The inspection team consisted of one inspector.
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 the information in the PIR, along with other information that we held about the service, including previous inspection reports and notifications. A notification is information about important events which the service is required to send us by law.
We contacted other health and social care professionals involved with the service, including the local authority safeguarding team and other commissioners of care.
We spoke with two people using the service. We also spoke with the interim service manager, the team leader and four care staff, one of whom was employed by an agency but had worked solely at the service for over three years. We observed the way people were supported in communal areas and looked at records relating to the service. These included three care records, three staff recruitment files, daily record notes, three medication administration records (MAR), maintenance records, audits on health and safety, records of accidents and incidents, policies and procedures and quality assurance records.
Updated
13 July 2016
This inspection took place on the 17 and 23 May 2016. The service was given 24 hours notice because the location is a small emergency respite service and we needed to be sure that someone would be there when we arrived..
Cornish Close Respite Unit was last inspected in February 2013 when it was found to be meeting all but one of the standards reviewed. A follow up inspection was carried out in June 2013 and the service was judged to have reached compliance in that standard.
Cornish Close Respite Unit is registered to provide emergency respite services for a maximum of six adults with learning disabilities. People may also mental or physical disabilities. At the time of our inspection, three people were using the respite service. There were plans in place for two of the people to move to a nearby house to be supported to live more independently in the future. The service was proposing to change the registration conditions of the respite unit to include support for people with dementia. The service was working closely with the local authority in relation to this.
We were told that the registered manager had been absent since August 2015. We had not been notified of this. 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. The provider had put interim measures in place in the absence of the registered manager.
Some people we spoke with had limited verbal communication. However, everyone clearly indicated they felt safe, were happy living in the service and liked the staff.
Staff had received training in safeguarding vulnerable adults and could clearly describe the action they would take if they suspected any abuse had taken place.
Two incidents had occurred immediately prior to the inspection, one of which had been reported to the local authority as a safeguarding concern. Both incidents reflected that practices at the service were not always safe .
We found that medicines were safely administered and staff received training in the administration of medicines. .
The home was clean and tidy and there were effective health and safety checks in place. Staff used personal protective equipment (PPE) such as gloves and aprons when undertaking personal care tasks and administering medicines.
The service had a safe system in place for the recruitment of new staff. There was a reliance on using agency staff at the service; however, the same people had been used for consistency. One person we spoke with employed by an agency had worked in the service for over three years. The company also had their own pool of bank staff and had recently recruited someone from this to a permanent position.
An induction programme was in place for new staff to complete required training courses and shadow existing staff. One person was eligible to be signed up to the Care Certificate and the service was liaising with head office in respect of this. Staff confirmed that they had completed training courses relevant to their role.
People’s care records and risk assessments contained personalised information about their needs The support plans we looked at included risk assessments, which identified any risks associated with people's care and had been devised to help support people to take positive risks to increase their independence.
We saw that the service had facilities to support people with a range of needs, including the availability of track hoists in bedrooms and bathrooms, although these weren’t currently required.
If people’s needs changed a system was in place to liaise with the person, their family and other professionals to update care plans and risk assessments. Where required people’s health and medical needs were met, with access to GPs and other health professionals.
We found that the service was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. People’s respite support was assessed and agreed with the person, their families and the local authority commissioning team prior to admission to Cornish Close Respite Unit. In the event of an emergency admission a support plan and risk assessments were supplied to the service.
During our inspection we saw that staff were kind and caring. People were given time to do things at their own pace and offered encouragement from staff. We also saw that staff knew the people they were supporting well.
We saw that activities within the service and in the community were available for people if they wanted. An outside courtyard area was available for people and trips out were arranged.
Staff told us that the upper management structure was currently blurred, given the long term absence of the registered manager, but they felt supported by the team manager of the unit. Regular team meetings were held and staff were able to raise any issues or concerns..
A system was in place for responding to complaints. We were told by relatives and staff that the team manager was approachable and would listen to their concerns.
There was evidence of some audits being undertaken at the service but we identified that overall, the systems in place to assess, monitor and improve the quality and safety of the service were not sufficiently robust.
During this inspection we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.