22 May 2014
During a routine inspection
Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.
Is the service safe?
The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have been have needed to be submitted, proper policies and procedures were in place.
Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments were undertaken when there were identified risks. For example in one care plan we saw an individual had a history of being non-compliant with taking medication. Staff were instructed to support the person with taking their medication, to report any side effects and to attend general practitioner (GP) appointments with them. We read 'client relapse/triggers' records which identified behaviours staff should be aware of that indicated people's mental health was deteriorating. This showed risk had been identified and appropriate action was taken to manage them.
The manager told us staff were able to identify the risk of abuse as they had attended relevant training, read the safeguarding adults policy and signed to confirm they understood the contents of the policy. This was further discussed at team meetings. A review of the two staff member's files, staff team minutes dated 20 May 2014 and 'staff signature sheets' confirmed this. This showed staff knew how to respond to any allegations of abuse.
Is the service effective?
We reviewed the service's 'Support Planning' policy and procedure which was revised on 31 January 2014. This informed staff to use the Mental Capacity Act (MCA) if they thought people did not have capacity to make decisions over certain area of their lives. One staff member we spoke with told us, 'We work together with external agencies and people's social workers would carry out mental capacity assessments if we were not sure they had capacity to give consent.' Another staff member commented, 'We contact peoples' families, advocates and social workers to help them understand and make a decision.' Both staff told us they had undertaken the relevant training, training records reviewed confirmed this. This demonstrated where people did not have the capacity to consent, the provider acted in accordance with legal requirements.
The manager told us people's care needs were assessed every three months by the 'care programme approach' (CPA) team. This is a particular way of assessing, planning and reviewing people's mental health needs. If people had severe mental health problems or a range of different needs their care could be co-ordinated under a CPA. We looked at a person's CPA review undertaken on 27 January 2014. This named all the people who were present such as the individual, people who represented them, their consultant psychiatrist, care co-ordinator and their link worker. The review took a holistic approach and looked at all aspects of the person's care and support needs. We saw what actions were agreed and who took responsibility to ensure they were completed. This ensured the care received was centred on the individual and all aspects of their individual circumstances.
Staff told us they received regular supervision. We heard comments such as, 'We have supervision every month to talk about any concerns we may have, the people we are supporting' and 'We discuss training needs, what needs to be done, any issues. I feel very much supported.' We saw annual appraisals were undertaken to review the objectives set. One staff member told us, 'my last appraisal was in January and it reflected how much I had progressed.' This meant supervisory arrangements were in place to ensure staff were supported and managed at all times.
Is it caring?
People told us they were happy with the way staff treated them. We heard comments such as, 'I like staff they don't use bad words. I am happy in this place' and 'when they give me my medication, they always speak to me in a respectful way.'
Is it responsive?
One person told us, 'When I am not well I get concerned because that's when I want to leave the home and if its night time, staff are asleep.' We relayed this information to the manager who told us the person had not attempted to the leave the home unaccompanied since they moved in however; they would speak with the person to assure them of what systems were in place. We looked at this person's care plan and saw their 'relapse/trigger' record. This gave clear indications for staff to follow if the person was having a relapse and what actions to take.
Is it well-led?
We saw a 'monthly visit to registered homes' was carried out on 17 April 2014. This was an inspection carried out by a manager from another service. The manager spoke with people to see if they were involved in their care plans and with staff members to see if they were being supported. The manager carried out an inspection of the premises and looked at the home's fire safety checks. This resulted in a visit action plan where issues were identified. For example, they found the emergency procedure was not displayed visibly in the reception area. The action was for this to be displayed correctly. On our arrival at the home, we observed the emergency procedure was clearly visible. We also noted quarterly monitor review meetings were undertaken by a visiting manager. We looked at the complaints log and saw complaints were clearly recorded and handled appropriately. This showed the service had system to regularly assess and monitor the quality of service provided.