Archived: The Lady Verdin Trust - Claremont

At our last inspection on 5 and 7 September 2017, the service was in breach of regulations relating to person centred care, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and governance. The service provider was also in breach of the regulation requiring them to display their rating.

We rated the service as 'Inadequate' and placed it into Special Measures. We asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) effective, responsive and well-led to at least good. 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 therefore no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. At this inspection the overall rating for the service is 'Requires Improvement'. The service had made some improvements and was no longer in breach of the regulations. However, we found that these improvements needed to be ongoing and sustained.

The lady Verdin Trust - Claremont 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 service accommodates up to four people in one adapted building. At the time of our inspection there were four people living at the service. 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, however they were about the leave the service. An application to register a new manager was in progress. 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.

Since the last inspection each person’s support plan had been reviewed and re-written. Risk assessments had also been reviewed. However, assessments were not always in place for all areas of identified risk. Work was ongoing on these. Despite gaps in the records, we found that appropriate actions had been taken to mitigate areas of identified risk.

Work had been undertaken to support staff to understand and apply The Mental Capacity Act 2005 (MCA). Information about people’s communication needs was included within their support plans. We saw that mental capacity assessments had been undertaken in a number of areas. Further work was needed to ensure that any best interest decisions were fully recorded. All Deprivation of Liberty Safeguards (DoLS) applications had been made since the last inspection and everyone living at the service had an appropriate authorisation in place.

People continued to receive their medication safely. Staff undertook training in the safe administration of medicines and records demonstrated that competency checks were completed. We identified some minor shortfalls in the recording around medicines and the management team took steps to address these.

Staff were trained in safeguarding procedures and understood their responsibilities to report any concerns of this nature. Since the last inspection the registered manager confirmed they had not needed to make any referrals to the local authority in relation to safeguarding concerns. However, there were procedures in place which staff understood should they need to do so.

We reviewed staffing levels during the inspection to ensure people were receiving a safe level of care to meet their identified needs. The management team told us that staffing remained under review and that whilst they were fully staffed they were considering the recruitment of staff for the weekends.

At this inspection we saw that action had been taken to ensure the provider could demonstrate how staff had completed appropriate training to meet people’s needs. Records showed that staff had undertaken training in topics such as health and safety, manual handling, safeguarding adults and MCA/DoLS. Staff told us that they felt supported. Regular staff supervision and appraisals were taking place.

People were supported to eat and drink sufficiently and maintain a balanced diet. They continued to be supported to maintain good health.

People appeared comfortable with the staff who supported them and we saw that staff were kind and patient in their approach. Staff knew the people they were caring for well and could explain people’s needs as well as their likes, dislikes and preferences. We found that people’s privacy and dignity were respected.

Since the last inspection each person’s support plan had been rewritten, with the input of support staff. Reviews had been held in consultation with people and discussion with relatives. Support plans reviewed contained a good level of personal detail that helped to guide staff to meet people’s needs in a personalised way. We saw that people's care was considered in relation to a wide range of needs including information about the sort of things that helped people to feel happy.

Importance had been placed on promoting independence and maintaining people’s skills. Goal plans were starting to be introduced and Improvements had been made in supporting people to take part in activities and follow their interests.

The registered provider had a policy and procedure in place for recording and responding to complaints. We saw that an easy read complaints policy was now available for people to access.

The service had been merging with another care provider and changes to the management structure were being implemented. The house manage was now based at the service and a new supervisor had been introduced. Staff felt well supported and said there had been an improvement in the organisation of the service. We saw that systems had been introduced to monitor whether staff received regular supervision, appraisal and that training was kept up to date. The management team had focused on better communication with staff and we saw that several staff meetings had been held over the previous few months.

Quality audits were now being carried out and systems to monitor the quality of the care were more effective.

We saw that the latest rating was on display at the location and the registered manager was aware of their duty to display this rating.

The Lady Verdin Trust – Claremont, provides personal care for up to four people with a learning disability. At this inspection they were providing care and support for four people.

A registered manager was in post and was available to us during day one of this inspection. However, owing to pre-arranged annual leave they were not present during day two. 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 the last inspection the service was rated overall good. At this inspection we found the service was in breach of regulations relating to person centred care, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and governance. The service provider was also in breach of the regulation requiring them to display their rating.

People did not have their individual rights protected. This was because the provider did not understand and apply their requirements to appropriately assess and submit applications for the Deprivation of Liberty Safeguards.

The provider had failed to assess the risks to the health and safety of service users of receiving the care or treatment.

People did not have information presented to them in a way they understood preventing them from making fully informed decisions. People’s individual capacity to make decisions was not assessed. As a result decisions were being made for people by the provider without the correct authority to do so.

People did not have effective, up to date or comprehensive care and support plans which reflected their individual needs. This put people at risk of inappropriate care.

The provider did not have effective quality monitoring systems in place to identify and respond to poor practice.

The provider had failed to display the previously rated performance.

People took part in a number of social and leisure activities, however, these were not extensive and there was little drive to increase people’s abilities, skills and interests. Individual goals and aspirations were not identified or promoted.

People were not consistently involved in decisions or changes in their home. People were not asked for their views and the provider did not have systems in place to consistently obtain people’s opinions.

People did not have up to date and accurate assessments of risk associated with their care and support. Assessments in place had not been effectively reviewed and did not account for changes in the person or their physical environment.

Staff members were not provided with specific training to enable them to support people with their individual needs

People were supported by enough staff to safely meet their needs. People received help with their medicines from staff who were trained to safely support them. The provider followed safe recruitment practices and completed checks on staff before they were allowed to start work.

The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if needed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We spoke to two relatives on the telephone during our visit. They both spoke very positively about the quality of care being to their relative and about the staff members working there. Comments included; 'staff are brilliant'. One person spoke very positively about their relative's keyworker describing her as; 'exceptional'.

The home had an adult protection procedure [now called safeguarding] that was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

The staff we spoke with confirmed that they regularly attended training and that this was up to date.

Because of its small size the home manager and staff members were able to react quickly to any issues that may arise. These could include support or care needs, medication issues or any problems with the facilities.

We spoke to two family members on the telephone. One person told us staff were very good keeping them informed of their relatives care and of any changes to their health. They told us they were very involved in any decisions made in respect of their relatives care and treatment. They said they 'like all the staff' and they were 'very happy' with the care and they had 'no problems at all'. They also told us the care was 'brilliant' and they knew their relative was happy living in the home and they knew they were ok.

Another person told us their relative's key worker was 'very good' and often brought their relative to visit them at home. They told us they went to meetings about their relatives care and were 'always consulted' regarding their care and informed. They said they were 'very happy' now their relative was living at the home.