Archived: United Response - 85 St Anne's Road East

This inspection visit took place on 20 June and 03 July 2017. The first day was unannounced and the second day announced. The inspection was prompted in part by notification of an incident following which a service user died. This incident is subject to a separate criminal investigation and as a result this inspection did not examine the circumstances of the incident. However the information shared with CQC about the incident indicated potential concerns about the management of health issues. This inspection examined those risks.

At the last comprehensive inspection on 25 February and 8 March 2016 we found breaches of legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to ensure staff were working in accordance with the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS) legislation and failed to operate and implement effective arrangements to monitor safety and quality across the service.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We carried out a focused inspection visit on 13 April 2017 to review action taken in relation to the breaches. We saw the service had made improvements and were no longer in breach of the regulations. Staff were working in accordance with MCA and DoLS.

At our inspection on 20 June and 03 July 2017 we saw staff were aware of safeguarding procedures and knew the action to take to protect people from the risk of abuse.

Risk assessments were in place which provided guidance for staff. This reduced risks to people.

Although people had limited verbal communication we were able to speak with them and observe staff interaction with them. They told us they felt safe with staff, and liked the staff who supported them. One person told us, "I do feel safe here." They said staff were kind and friendly.

Medicines were stored securely, administered as prescribed and disposed of appropriately.

There were sufficient staff available to provide personal care and individual social and leisure activities. Staff received training to carry out their role and were knowledgeable how to support and care for people. They had the skills, knowledge and experience to provide safe and effective support.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

People told us they were happy with the variety and choice of meals available to them.

Care plans were personalised detailing how people wished to be supported. People who received support or where appropriate their relatives were involved in making decisions about their care. Their consent and agreement had been sought before providing care.

People who used the service or their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise any concerns.

Senior staff monitored the support staff provided to people. They checked staff supported people in the way people wanted. Audits of care and support records and risk assessments were carried out regularly. People and their relatives were encouraged to complete surveys about the quality of their care.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 13 April 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the latest inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for United response – 85 St Anne's Road East on our website at www.cqc.org.uk.

United Response – 85 St Anne's Road East is a small care home registered to provide care and accommodation for up to six people. The home is located close to St Anne's town centre, local services and public transport. At the time of the inspection visit four people lived at the home.

There was a registered manager in place. Although they were unavailable when we inspected. However the area manager was available to provide information during the inspection. 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 focused inspection on 13 April 2017, we found that the provider had followed their plan which they had told us would be completed by April 2016 and legal requirements had been met.

We checked what progress had been made in completing mental capacity assessments in relation to each person. Records seen demonstrated mental capacity assessments had been carried out and established people did not have capacity to make the decisions identified.

Audits and monitoring of the care provided had been regularly completed. Accidents and safeguarding concerns were monitored and evaluated for lessons learnt. Medicine checks were completed daily and audited weekly. This reduced the risk of medicines errors. House meetings, team meetings and manager meetings were held regularly to make sure staff were kept informed and up to date with any actions, ideas and changes. This assisted in providing safer governance.

We could not improve the rating for effective or well led from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

There were five people who used the service at the time of the inspection.

The service was last inspected on 30 April 2014 and was found to be compliant in all the areas assessed.

This inspection took place on 25 February and 8 March 2016. The first day of the inspection was unannounced. The inspection was carried out by an adult social care inspector.

A new manager was appointed to the service at the time the inspection took place. The new manager advised us that they intended to apply to the Care Quality Commission to be registered as a manager. 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 service had experienced significant changes in the management team due to the appointment of the new manager and a new area manager at the same time. We found during this inspection that the service had lacked leadership for some time and as a result, some aspects of staff support such as team meetings and individual supervisions had fallen behind.

Procedures to check the safety and quality of the service had not been properly utilised and as a result, opportunities to identify and address areas for improvement had been missed.

We found that the service was not working in accordance with the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards legislation. This meant the rights of people who did not have capacity to consent to any aspects of their care or support may not be fully protected.

The management of medicines was found to be generally satisfactory. However, we noted improvements could be made in relation to medicines records and auditing. We made a recommendation about this.

People we spoke with expressed confidence in the service and spoke highly of the staff team. We noted there had been an increased use of agency staff over recent months, which was potentially detrimental to the consistency of care received by people who used the service. However, this issue had been identified by the new management team, who were taking steps to address it.

People were supported to access health care when they required it. Staff had a good understanding of people’s needs and the support they required.

People we spoke with felt their loved ones were treated with kindness, dignity and respect. People led full and active lives and were supported to take part in activities they enjoyed, both inside and outside the home.

Staff were carefully recruited and provided with training that assisted them in meeting the needs of people they supported. Staffing levels at the service were calculated in line with the needs of people who used the service and were adequate to meet their personal and social needs.

People felt able to express their views and raise concerns about their care, or the service as a whole.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to consent and good governance.

You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the Service Safe?

People's care was planned in line with their individual needs. Any health related risks were identified and addressed. Staff had a good understanding of people's care needs and how to support them safely.

Staff ensured that any person requiring medical support was supported to access it in a timely manner. When medical advice was given by community health care professionals, staff ensured it was incorporated into people's care plans.

Staff were trained in the protection of vulnerable adults and were aware of the action they should take in the event that they had concerns about the safety or wellbeing of someone using the service. There were arrangements in place to ensure that any safeguarding concerns were reported to the appropriate authorities and investigated.

Processes were in place to ensure appropriate background checks were carried out for all staff employed at the home. This helped to ensure that people received their care from staff of suitable character.

There were systems to assess quality and identify risks to people using the service. Staff received adequate training in health and safety related areas to help ensure they had the skills to support people safely.

Is the service effective?

People we spoke with expressed satisfaction with their, or their loved ones' care. People felt that the staff team were competent and provided with the resources to meet people's needs effectively.

One relative told us his family member had recently had some health issues, which staff had identified quickly. He went on to explain his relative had been supported to access the appropriate medical advice.

Staff had a good understanding of people's needs and worked well with external professionals to ensure people received the care they required.

People's care was planned in line with their individual needs and wishes and there was a good level of support in relation to people's social care needs. One resident we spoke with told us they received weekly support to carry out a voluntary job. He also spoke of the social activities he enjoyed every week in his local community.

Is the service caring?

We received very positive feedback from everyone we spoke with about the service. One resident said, 'I like it in this house and I like them lot (staff)!' Other residents were not able to tell us their views but we observed them as they went about their day and noted they appeared content and relaxed in their surroundings.

Relatives we spoke with were highly complimentary about the approach of staff at the home. One person commented, 'The care workers really do care.' Another spoke of their patience and kindness and told us they were always made to feel welcome when they visited the home.

We viewed people's bedrooms and saw they were nicely decorated and furnished. Bedrooms were very personalised and it was apparent staff had taken time to support people in choosing d'cor and personal items that reflected their individual tastes.

Is the service responsive?

People told us they found the manager and staff approachable and supportive. People commented that they would have no hesitation in raising any issues of concern should they arise.

The provider issued service uses with a pictorial, easy read charter, which was produced in line with their individual needs. This helped ensure residents were aware of their rights and how to raise any concerns.

Through discussion with families and through viewing care records, we were able to confirm that staff were able to identify changes in people's needs and responded effectively. Staff worked well with external professionals and ensured any advice they provided was included in people's care plans.

Is the service well-led?

There was an experienced manager in place who had a good understanding of the role and the importance of monitoring safety and quality.

There were numerous processes in place to assist the manager in monitoring quality and safety and identifying risks to people who used the service.

Where risks to the health or wellbeing of people who used the service had been identified, there was clear guidance in place for staff to help keep people safe.

Auditing systems helped to ensure the service learned from any adverse incidents such as accidents or near misses. There were systems for recording complaints or safeguarding concerns so that any themes or trends could be identified and addressed.

At the last inspection we had been concerned about the care and support people received, record keeping and staff training. This had improved on this inspection. People were receiving good care and support, record keeping was satisfactory and staff were receiving appropriate training. Since the last inspection the registered manager had returned to the home. He and the staff team had made changes in the home to improve the quality of care provided.

People were treated in a respectful and dignified way. Staff assisted them quickly and effectively and they were involved in social and leisure activities. We spoke with several relatives about the care their family member received. Relatives said that the staff were very caring and their family member was well looked after.

Care records were in place and had been reviewed. Changes in health were noted, records updated and the advice of other professionals sought. There were clear guidelines about how to manage challenging behaviour and staff were putting these guidelines into practice.

We saw some people receiving good care which met their needs and our observations showed they were smiling and relaxed. However we had concerns over the interaction between two people and the lack of consistent staff response to this.

Although staff had received some training in care, for most people this was several years ago and the training had not been updated. Despite one person having behaviour that challenged, staff had not received challenging behaviour training. This meant that staff did not have current, up to date skills and knowledge to support people effectively.

Staff meetings were not taking place and staff were not receiving formal supervision. This limited their opportunities to be involved in changes in people's care and routines in the home.

Records were not fully completed, up to date and accurate. This affected the care and safety of people.