Background to this inspection
Updated
11 May 2017
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 was 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. The inspection was carried out to check that improvements to meet legal requirements, identified in two warning notices, had been made. This inspection also checked to see whether breaches of legal requirements made as a result of the last inspection on 16 and 18 August 2016 had been met.
This inspection took place on 21 March 2017 and was unannounced. One inspector undertook the inspection.
Prior to 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 reviewed the PIR and other information we held about the service including previous inspection reports. This included statutory notifications sent to us by the provider about incidents and events that had occurred at the service. A notification is information about important events, which the service is required to send to us by law. We used all this information to decide which areas to focus on during our inspection.
During the inspection, we observed care provided by staff to people including how medicines were administered to people and the lunchtime experience. We met with four people living at the service. Due to the nature of people's complex needs, we were not always able to ask direct questions. However, we did chat with people and observed them as they engaged with their day-to-day tasks and activities. We spoke with the acting manager, senior support worker and two care staff. We also met with the Practice Development Advisor employed by United Response to review how the service proactively supports people’s behaviours. On the day of the inspection, we received contact via email from a Director representing United Response who was unable to meet with us face to face.
We spent time looking at records including care records for 10 people, five staff files and staff training records. We also looked at staff rotas, medication administration records (MAR), health and safety maintenance checks, compliments and complaints, accidents and incidents and other records relating to the management of the service.
Updated
11 May 2017
The inspection took place on 21 March 2017 and was unannounced.
The service is a residential care home, which provides care and support for up to five people with a learning disability. At the time of our inspection there were five people living at the home. The service is a detached three-storey building, with an open plan lounge and dining room, which leads into a small conservatory. On the ground floor are a kitchen and two utility rooms leading out to a well-kept garden. There is a downstairs toilet and a bathroom on the first and second floor. The service had a cat named Smudger, which people told us they liked having around.
At the last inspection on 16 and 18 August 2016, we identified seven breaches of Regulations associated with assessing the risks to the health and safety of people, systems and processes around safeguarding people from abuse and improper treatment, staff supervision and training, personalised care, how the provider received and acted on complaints and effective good governance. The provider had also failed to notify the Commission of two incidents of alleged abuse. As a result, the service was rated 'Inadequate' overall and the provider was placed into Special Measures by CQC. We met with the provider to discuss our concerns and issued two Warning Notices, which required the provider to take immediate action in relation to assessing the risks to the health and safety of people and the effective governance of the service.
We recommended the provider ensured consistency in the caring approach of staff to ensure people's dignity and well-being are promoted. We also recommended staff training in Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Following the last inspection, the provider wrote to us to confirm that they had addressed these issues.
Since our last inspection, the provider has continued to engage with the Commission. We required the provider to submit regular action plans that updated us about the steps they had taken to improve the service. At this inspection, we found that the actions had been completed and the provider had now met all the legal requirements. Since our last inspection, the service had experienced a period of considerable change. Although significant improvements had been made to address previous shortfalls raised in our last visit, the service is on an improvement journey and these improvements were yet to be embedded and sustained.
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 did not have a registered manager in post at the time of our visit. Following our last inspection, the newly appointed manager left the service in December 2016. The provider appointed another manager in March 2017; however, they have not yet commenced employment. The service has been without a registered manager since August 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. An interim manager who had been in post for three weeks was managing the service day to day.
The recent focus had been on changing the culture of the service. Other areas of improvement had been identified, but not wholly implemented. For example, at the last inspection some people told us they did not feel safe because of the behaviours some people who used the service displayed. We identified that safety incidences were not always analysed and responded to effectively. This meant the risk of further incidents were not always reduced, which could have put people at risk. At this inspection, we found that incidences were still not being fully documented which meant we could not identify how people’s needs were being responded to. Whilst the management team had appointed a Practice Development Advisor to review people’s behaviour care plans and support the staff in preventing and responding to people’s behaviours, people told us they still did not feel entirely safe. This area requires further improvement.
At the last inspection, the provider's systems and processes designed to monitor the quality of the service were not always followed. Internal audits and checks did not identify issues, which were affecting people's safety and wellbeing. At this inspection, we found systems for monitoring quality and auditing the service had improved and were being used to continually develop the service. However, not all systems and processes designed to monitor the quality of the service had been fully embedded. This area requires further improvement.
People were protected against the risk of abuse; staff had a good understanding of how to recognise abuse and what action they should take if they suspected it had taken place. Staff were provided with training relevant to their role and felt well supported by management.
Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed safely.
Safe staff recruitment procedures ensured only those staff suitable to work in a care setting were employed. Sufficient numbers of care staff were deployed to meet people's needs. We saw that staff recruited had the right values, and skills to work with people who used the service.
At the last inspection, we observed the premises were not always clean or properly maintained. At this inspection, we found noticeable improvements had been made to the home environment which had been service user led. The home was clean and tidy throughout, routinely maintained and monitored by the provider.
People's capacity to consent to care was considered and the home worked in accordance with current legislation relating to the Mental Capacity Act 2005 and the Deprivation of Liberties Safeguards. This included training for all staff on both subjects, which was a recommendation at our previous inspection.
Care plans reflected information relevant to each individual and their abilities, including people's communication and health needs. Staff were vigilant to changes in people's health needs and their support was reviewed when required. The service had good links with health care professionals to ensure people kept healthy and well.
People were provided with a variety of meals and the menu catered for any specialist dietary needs or preferences. Mealtimes were often viewed as a social occasion, but equally any choice to dine alone was fully respected.
People looked happy and were relaxed and comfortable with staff. They were supported by staff that understood their needs and abilities and knew them well. Staff were kind and caring towards people and upheld their privacy and dignity at all times. People were involved as much as possible in planning their care. Staff were flexible and responsive to people's individual preferences and ensured people were supported in accordance with their needs and abilities. People were encouraged to maintain their independence and to participate in activities that interested them.
The service placed a strong emphasis on meeting people's emotional well-being through the provision of meaningful social activities and opportunities. People were offered a wide range of individual activities, which met their needs and preferences. There were processes in place for people to express their views and opinions about the service provided. The feedback from people and their representatives in their most recent customer satisfaction survey was positive. The complaints procedure was displayed and people said they knew what to do if they were not satisfied with the service. Complaints were logged and records showed the provider looked into complaints and responded to complainants.
As a result of improvements made to the quality and safety of Burnham Avenue, the overall rating of the service had improved from 'Inadequate' to 'Requires Improvement'.