Archived: Respond

Updated 13 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 was an unannounced inspection which took place on 25 and 30 April 2018 and was carried out by and adult social inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed all the information we held about the service. We looked at notifications the provider was legally required to send us. Notifications are information about certain incidents, events and changes that affect a service or the people using it.

We looked at the provider information return (PIR) which the provider sent to us. 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 also looked at all the information we have collected about the service.

As part of our inspection we spoke with three relatives of people who used the service. We were unable to speak at length to any of the people who used the service, due to their capacity to understand. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

We spoke with the registered manager; two senior care workers and two care workers. We looked at two care records, four staff records and records relating to the management of the service.

Updated 13 July 2018

Respond is a residential adult care service for short-term respite which is managed by Slough Borough Council. The service currently provides critical respite care to adults with learning disabilities. It offers both planned and emergency support to enable families to take scheduled breaks from their role of caring for people living at home. The service also provides an emergency placement facility. At the time of our visit the provider was carrying out a programme of building works and re-development for Respond and another one of its services. This meant six people from another service had temporarily moved into the respite service. Therefore, only two out of the eight available beds were used for respite. During our inspection there were two people using the respite service.

A manager was in post and was registered with us since October 2010. 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 and associated Regulations about how the service is run.

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 difficulties and autism using the service can live ordinary a life as any citizen.

At our previous inspection on 13 and 14 January 2016 we found a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009. We asked the provider to take action to make improvements in the key question of well-led. This was because the service did not notify us without delay of DoLS authorisations approved by the supervisory body and safeguarding alerts raised with the local authority. We asked the provider to send us an action plan to show the what improvements would be made, by 28 March 2016. The provider failed to submit the action plan.

During this inspection, we found the service still did not notify us of certain events. When notifiable safety incidents happened, the registered manager did not follow actions as required under the duty of candour regulation. Although relatives felt the service was well managed, we found a negative workplace culture amongst staff, who felt unsupported and not listened to. Governance and performance management systems were not always reliable and effective.

Staff were not appropriately inducted; trained and supervised. People’s personal safety had been assessed and plans were in place to minimise identified risks. We noted these were not always reviewed.

People were supported to have maximum choice and control of their lives. However, the service was not always compliant with Mental Capacity Act 2005 and its codes of practice, as some people were unlawfully deprived of their freedom.

Relatives were positive about the caring nature of staff. We heard comments such as, “Staff members are fantastic, wonderful, and very patient; I have never had any problems. They speak to my daughter as if she is a human being” and “I know the staff well and I trust them. My son comes back (home) very happy and is very comfortable at the unit and with all the staff. I think the unit has a homely feel.”

Staff knew people’s care and support needs. We observed they were very friendly, caring and had a very good rapport with the people they interacted with. Staff gave examples of how they protected people’s privacy, confidentiality and promoted their independence.

Relatives felt their family members were kept safe from abuse. A relative commented, “Once there was bruising and staff phoned straight away to find out if I was aware, which I was and I know she gets bruises when she rides the cycle.”

Staff knew how to protect people from harm. There were sufficient numbers of suitable staff to care and support people to stay safe and robust recruitment practices were in place to ensure people. Medicines were administered safely. There was some confusion regarding medicines as two different systems were in use. We have made a recommendation about medicines management.

People’s nutritional and health needs were met.

Relatives felt the service was responsive to people’s needs. Plans of care were person-centred to ensure they met people’s specific needs. The service was compliant with the accessible information standard (AIS) to ensure people with a disability or sensory loss can access and understand information they are given. Relatives knew how to raise concerns but felt there were no need to as any concerns raised were dealt with promptly.

We found six breaches in the regulations as a result of this inspection. You can see what action we told the provider to take at the back of the full version of this report.