Archived: United Response - 33 Station Road

33 Station Road is a care home on the outskirts of Chesterfield. The service offers personal and social care for up to six people with a learning disability and associated conditions. At the time of our inspection there were four people using the service.

The accommodation was over three floors and consisted of a lounge area, kitchen, separate dining room, bathroom with accessible equipment and two further shower rooms and toilets. The bedrooms were spread across the three floors. There was a lift available to support people to gain access to the upper floors. There was a large garden area to the rear of the property for people to use.

The provider has recognised the importance of the principles and values that underpin Registering the Right Support and other best practice guidelines and there has been acknowledgement from the provider that the current property was no longer suitable to meet the needs of the people living there, and alternative accommodation had been sourced. This guidance ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

At the time of our inspection four people were using the service. There were deliberately no identifying signs, intercom system, cameras, outside the property to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

Three months prior to our inspection we received information from the provider to highlight areas of risk within the service. The provider completed an action plan and had kept us informed of the changes they had made. We found that improvements had been made; however, some areas still required further actions and to provide us with the assurance of sustainability.

Improvements had been made to the documentation and systems to record and monitor people’s care. Previously, care plans had not been consistently updated and were not readily available for staff to provide people with their current care needs. Staff were now knowledgeable about people’s health conditions and support needs. These changes now need to be embedded and become part of the standard information.

Prior to the involvement of the internal quality audit team, the governance of the home had been insufficient to ensure that people received support to keep them safe and maintain their wellbeing.

Audits had not always been completed or used to develop improvements. Partnerships with health professionals had not always been developed to enhance the care available to support people and the staff. Where guidance had been provided, this had not always been followed. We saw recent improvements had been taken to address these issues and we now needed to be assured they could be sustained

Improvements had been made to staff training and support, there were plans in place to ensure all staff training was completed in a timely manner in the future.

People were safeguarded from the risk of abuse and avoidable harm and information was available for people on how to report any safeguarding concerns. Staffing levels were sufficient at the time of the inspection.

People received their prescribed medicines when they should, and staff had the required information to manage and administer medicines safely. The prevention and control of infection was managed safely. There was enough equipment to meet people’s needs. Health and safety checks on the environment had not always ensured people’s needs were effectively managed, however these have now been addressed. The provider anticipates the plans for alternative accommodation will address the remaining concerns.

Where people required support from staff with eating and drinking, this was provided by staff who were caring and unhurried. This supported people to have a positive mealtime experience.

People received care and treatment from staff who had a kind, caring and person-centred approach. Staff treated people with dignity and respect and their choices and decisions about how they received their care was upheld.

People’s communication needs were known and understood by staff. Advocacy information was available for people. People received opportunities to participate in social activities, these reflected people’s interests, hobbies and diverse needs.

People had access to the provider’s complaint policy and procedure; any complaints were acted upon quickly. People’s end of life care and wishes had been assessed and planned for. People were invited to share their views and wishes about the service they received, and staff felt involved in the development of the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 6 December 2018) and there was a breach of Regulation 12. The provider had completed an action plan after the last inspection to show what they would do and by when to improve. Following a visit by the providers internal auditors in September 2019, it was identified several actions had not been completed and a team of experienced managers became involved, to further support the service to identify and act on concerns found.

At this inspection, we found improvements had been made and the provider was no longer in breach of the regulation. However, the service remains rated Requires Improvement until recent practices become fully embedded and sustained. This service has now been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 33 Station Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The accommodation consisted of a lounge, a kitchen and dining room, six bedrooms and a bathroom. There was a large garden at the rear of the property for the people to use. There were good public transport links to local amenities.

United Response – 33 Station Road 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. 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.

The service had a registered manager in place at the time of our 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 last inspection in June 2016 we rated the service, good. At this inspection we found improvements were now needed and the service is rated as Requires Improvement.

Quality monitoring systems were not always effective. Improvements had not been identified that people did not always have a care plan that reflected their needs and risks that had been assessed. Improvements were needed to ensure medicines were recorded and stored safely and to staffing needed to be reviewed to ensure support was available for people. We have made a recommendation about how staffing is provided. Staff listened to people’s views about their care although information was not always in a format that was meaningful to people. People did not receive information about how their views influenced the service provided.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Where staff were concerned about safety they knew who to speak with. People were supported by staff who had the knowledge and skills to provide safe care and support. The registered manager monitored the staff’s learning and developmental needs to ensure staff had developed the skills they needed to support people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and they were helped to make decisions which were in their best interests. Where people’s liberty was restricted, this had been done lawfully to safeguard them.

People could develop their independence and were provided with opportunities to develop their interests and join in social activities. People’s health and wellbeing needs were monitored and they were supported to organise and attend health appointments as required.

People were treated with kindness, compassion and respect and staff promoted people’s independence. People liked the staff who supported them and had developed good relationships with them.

People were involved in the review of their care and staff supported and encouraged people to go out and maintain relationships with their families and friends.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Our previous inspection visit in December 2013 found that improvements were needed in obtaining people's consent to care and treatment, ensuring people's care and welfare needs were met, security of care records, management of medicines, maintaining a safe and pleasant environment and managing complaints.

This is a summary of what we found.

Is the service safe?

People we spoke with told us they were able to make decisions about their daily life and that staff explained important issues to them.

We found the arrangements were suitable to ensure people's best interests were established and the legal requirements of the Mental Capacity Act (MCA) were being adhered to.

We found the storage of medicines had improved since our previous inspection visit in December 2013 and medicines were now stored securely and there was a refrigerator available for those medicines requiring cool storage. We also found the provider had improved the recording of the efficacy of 'as required' (PRN) medicines.

We found there was an error in the calculation of number of tablets for one medicine on one person's record and there was one unidentified tablet in a medicine pot in the storage cupboard. This meant that staff were not always following proper procedures for the safe management of medicines.

We saw the provider had taken steps to improve the suitability of the premises such as the provision of a new bath, repair of damaged walls and new worktops in the kitchen, although some work was still outstanding, such as the widening of the doorway into one person's bedroom.

Is the service effective?

People we spoke with told us they enjoyed using the service; one person said 'It's ever so nice here'. A relative we spoke with told us 'I'm pleased with what I've seen' and confirmed their family member had improved since using the service.

Our previous inspection visit in December 2013 identified that steps had not been taken to ensure people were always receiving safe and appropriate care. We found this had improved on this visit and we saw there was information available on people's individual health needs and that appropriate external health professionals, for example, speech and language therapists, were involved as required. An external health professional told us they had no concerns about the service and another confirmed that their advice was acted on. One professional told us that the person they were involved with had improved since using the service.

Is the service caring?

People we spoke with told us they liked the staff and one told us 'I get on very well with the staff'. A relative we spoke with described the staff as very caring.

We saw people were enabled to participate in community activities, such as attending religious services, and that individual lifestyle choices were respected. We saw staff had warm and friendly relationships with people and treated them respectfully.

Is the service responsive?

We found the service involved other health professionals as necessary, including speech and language therapists, dentists and General Practitioners. Staff told us the training they received was relevant to their job and equipped them to perform their role. However, we found that due to the increasing age of the people accommodated, more specialist input relevant to the needs of older people would be beneficial, for example regarding falls prevention and pressure ulcer prevention.

Is the service well led?

We saw staff received support and training to enable them to perform their role satisfactorily although the provider should note some relief staff who worked in the service regularly did not receive supervision as often as other staff. This meant there was the potential for some staff not to receive the right guidance to perform their role to a satisfactory standard.

Our previous inspection visit in December 2013 identified that there were different versions of the complaints procedure on display around the premises. We saw that this had improved and there was now an up to date complaints procedure with pictorial information to aid understanding. It also found that there was inadequate secure storage for people's records. We saw that this had improved and the office was now lockable and there were lockable filing cabinets available for secure storage. This meant personal information was now handled in accordance with legal requirements.

We observed that people receiving care were clean and well dressed. People told us about the holidays they had each year and told us they liked living at the home.

Where people had capacity to make decisions they were consulted and given information to help them make choices in an informed way. Where people did not have capacity we saw there were not systems in place to demonstrate decisions had been reached in people's best interests.

Some care needs were identified and assessed. However we found that the planning and delivery of care did not always meet the person's individual needs and or ensure the welfare of the person.

Staff monitored medication stock levels regularly. Medications were not always given to people in accordance with the prescriber's instructions. Medicines requiring refrigeration were not suitably stored.

A homely environment was provided for people to live in. Routine maintenance works were completed quickly however significant repairs such as replacing a bath were not attended to in a timely manner.

There were systems in place to handle complaints but people did not have access to up to date information on who they could complain to.

Another relative told us that they had visited regularly and felt that the home was clean and the staff were reasonable. They said they knew most of the staff well and thought they provided good support. They had had concerns about one member of staff who had left.

One person told us they were quite content living there and looked forward to their holiday.

We saw that the standard of decoration was poor in some areas and that one person who used a wheelchair had difficulty moving about within the home. The manager told us they were about to re-decorate.