The inspection took place on 30 and 31 August and 03 September 2018, the first day was unannounced. This was the first inspection of the service under the provider Making Space since their registration with the Care Quality Commission (CQC).
This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.
People who used this service lived in their own apartments with access to communal areas, for example an activities room, large bathrooms, a bistro and a hairdressing salon. The registered manager and care staff had access to a large office on site and a staff rest area, which they shared with the housing provider.
Not everyone who used the service received the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; for example, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection there were 21 people receiving the personal care service.
There was a registered manager at the service. 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 this inspection we identified breaches of the Regulations in relation to safe care and treatment, person-centred care and good governance.
You can see what action we told the provider to take at the back of the full version of the report.
The management of medication was unsafe. People did not receive their prescribed medication because the stock had run out and medication stocks did not always tally with records. Handwritten medication administration records (MARs) had not been signed by two staff to ensure the accuracy of the information recorded. There were no protocols in place to guide staff on the use of medication prescribed to people to be given ‘when required’ (PRN). In addition, there was no information to guide staff on the application of topical creams which people were prescribed and required assistance from staff to apply. There was a lack of checks carried out on people’s medication and a failure to act upon areas for improvement which were identified through audits carried out prior to our inspection. Following the inspection, we were provided with details of the action taken to ensure the safe management of medication.
Risks to people were not always assessed and mitigated. Risk assessments had not been carried out for some people to determine if there were any measures which needed to be put in place to keep them safe. One person had epileptic seizures, however no risk assessment had been completed for this. No risk assessment had been completed for another person who had difficulties mobilising independently and required staff to assist them with transfers using a stand aid. In addition no risk assessment had been completed to determine whether it was safe for a person to self-medicate. Following the inspection, we were provided with records to show that risks to people had been assessed and planned for.
Personal information about people was not safely managed in accordance with the General Data Protection Regulation (GDPR) and relevant data protection law. Files containing people’s personal records were displayed in an open cabinet in an office which was occupied by unauthorised people with no staff present. This put people’s confidentiality at risk. We raised this immediately with the registered manager and they secured the records. Following the inspection we were assured that the registered provider had took appropriate action by reporting this incident to in line with the GDPR Regulation.
People’s needs were not always assessed and planned for to ensure they received effective care and support responsive to their needs. People received care and support without a plan of care in place. This meant that there was no information to guide staff on people’s needs, how they were to be met and what the intended outcome was for the person. This also meant there was a lack of consideration given to planning personalised care and support. For example, obtaining people’s choices and preferences with regards to their care and support and identifying with them their strengths and abilities. Care was provided to people based on staff knowledge of them rather than specific evidence based guidance.
Care plans were not always kept under review to ensure they remained relevant and up to date. This also meant that people and where appropriate, relevant others were not given the opportunity to reflect on the care and support provided and make any changes to their plans should they wish to.
The service was not being managed in accordance with CQCs registration requirements. This was because records for people supported and staff were not all held at the registered location. This was an oversight by the registered provider and they acted to rectify this following the inspection.
The systems in place for assessing and monitoring the quality and safety of the service and making improvements were ineffective. Audits (checks) had not taken place at the required intervals, therefore there was a failure to identify and mitigate risks to people. This included risks associated with the management of medication and assessing and planning people’s care. Where audits had taken place, areas identified for improvement were not followed through and remained outstanding at the time of inspection. There was a lack of oversight and monitoring of the service by the registered provider to ensure appropriate action was taken to mitigate risks to people.
People who used this service told us that they felt safe using it. Information about safeguarding people was available to staff and they underwent training to raise their awareness of the different types of abuse and how to report any concerns they had. Staff were confident about recognising and reporting any incidents of abuse which they witnessed, suspected or were told about. Staff had completed training in topics of health and safety and there were plans in place to support people safely in the event of an emergency.
Safe recruitment procedures were followed. A range of information was obtained in respect of applicants to help the registered provider assess their suitability for their job role. This included checks carried out with previous employers and with the Disclosure and Barring Service (DBS) to check on applicant’s criminal background. There were sufficient numbers of suitably qualified and skilled staff to safely meet people’s needs and keep them safe. Staff were provided with training relevant for their roles and they felt well supported.
The registered manager and staff understood their responsibilities for ensuring people’s right to make decisions in line with the Mental Capacity Act (2005). They knew people had the right to make decisions for themselves unless others had the legal authority to act on their behalf through a Court of Protection (COP) order. People told us that staff offered them choices and obtained their consent prior to carrying out care and support.
People told us that staff were kind and compassionate towards them. People provided us with examples of how staff expressed their kindness. This included staff shopping for people and spending time with people in their own time.
People were provided with information about how to complain and they were confident about complaining should they need to.