Background to this inspection
Updated
8 April 2016
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 was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, looked at the overall quality of the service, and provided a rating for the service under the Care Act 2014.
The inspection took place on 18 February 2016 and was unannounced, which meant the staff and provider did not know we would be visiting. The inspection team consisted of one inspector.
Before the inspection we reviewed previous inspection reports and looked at notifications sent to us by the provider. A notification is information about important events which the service is required to tell us about by law.
Some people living at 33 Montserrat Road were unable to tell us in words how they felt about the home. We tried to ascertain their views by observing their behaviour and looking at records of how staff gathered this information.
We spoke with two of the four people living at the home and observed care and support given to three of the people who lived at the home. We spoke with the manager who was managing the service at the time of the inspection and two staff.
During our inspection we observed how staff interacted with people who used the service and supported them in the communal areas of the home. We looked in depth at the care records for two people. We looked at the medicines records and we viewed accident and incident records, staff recruitment and training and supervision records. We reviewed a range of records relating to the management of the service such as complaints, quality audits, policies and procedures.
This was the first inspection under a new provider although the staff and manager remained the same as those that were employed under the previous provider. The service was registered on 3 July 2014.
Updated
8 April 2016
This unannounced inspection took place on 17 February 2016.
33 Montserrat Road provides support and accommodation for up to four people who live with a learning disability within the age range of late forties to early sixties. On the day of our inspection there were four people living at the home.
The service had a registered 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 registered manager was unavailable on the day of the inspection. The registered manager for the service has been on leave since December 2015 in the interim a manager from another service is overseeing the day to day responsibilities of the service. They are the manager referred to in the report.
Staffing consists of one member of staff available for people between the hours of 7.00 am and 10.00 pm. The manager was reviewing people’s needs alongside social services and they were working with the provider to match people’s needs to staffing levels.
Risks associated with people’s care had been identified, but these had not always been updated as people’s needs and risks changed. The manager was ensuring risk assessments were being updated. Incidents and accidents were being logged.
Staffing consists of one member of staff available for people between the hours of 7.00 am and 10.00 pm. The manager was reviewing people’s needs alongside social services and they were working with the provider to match people’s needs to staffing levels.
CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. There had been times when decisions had been made regarding people’s capacity and ability to leave the home. However, manager reported that applications had been submitted to the local authority in relation to the people who lived at 33 Montserrat Road where necessary and these were pending. Records we saw confirmed this.
All staff had completed mandatory training however; some training had not been renewed before it had expired. Some staff had not accessed training that was needed to meet people’s needs for example epilepsy awareness. Procedures in relation to recruitment of staff were followed ensuring people were kept safe. In the past month the current manager had arranged training updates for staff.
People had developed good relationships with staff who were kind and caring in their approach, however there was not always staff consistency. People were treated with dignity and respect.
Paperwork associated with people’s care had not always been kept up to date. It was difficult to see where staff had included people in the development of the care plans. People were provided with activities but these were not always matched to meet individual preferences and consisted of routines such as going to the local café or sweet shop. However, we saw changes had been made and the manager was working with staff on this. These changes will need to be embedded in practice.
There were clear procedures in place for safeguarding people at risk and staff were aware of their responsibilities and the procedures to follow in keeping people safe.
People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. People’s physical and emotional health was monitored and appropriate referrals to health professionals had been made.
A system of audit was in place however until recently it was not clear from records how these had been used to identify where improvements could be made. The manager was working with staff on this.
The provider Sanctuary Supported Living carried out a full audit of the home in January 2016. The provider had recognised in their audit that there had been a failure in systems and processes available to assess and monitor the quality of the service which would mitigate the risks relating to the health, safety and welfare of people. Their action plan and the management now in place sought to remedy this and we saw from the action plan and looking at records that a lot of work had been completed already. There was more to be done followed by the embedding of good practice and systems.
We found breaches 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 this report.