Archived: Esther Randall Court

Why we inspected

We undertook this targeted inspection to look at concerns that were raised about cleanliness, personal care provided to particular people who at times required two staff to support them, the use of medicines, management of people’s finances, staff recruitment background checks and staffing levels in March 2021. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found the following examples of good practice.

The service worked hard to encourage people to maintain social distance despite people living at the home finding it difficult at times to fully understand why this was necessary. Most people had not had visitors during the COVID-19 pandemic. For much of the last year there had been restrictions about visiting and some people had been following the government advice around shielding. The service had adapted communal space on the ground floor to allow for socially distanced visiting outside of people’s own separate accommodation if they wished to receive visitors. The registered manager and staff we spoke with told us about how they had continued to encourage and support people to maintain contact with their loved ones even if they were unable to see them in person.

We invited people using the service to speak with us during our inspection visit but on this occasion, no one wished to. We received positive feedback from the local authority that commissions the service. We were told that the authority had been made aware of the concerns raised but had found nothing to substantiate the concerns and that the service had managed very well, not least during the pandemic.

At the last inspection on 9 December 2015, the service was rated Good in all key questions and overall. At this inspection we found the rating for the service remained Good but it was rated Requires improvement in well-led.

There was a registered manager in post. 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 registered manager had relevant experience and training to provide regulated activity.

The registered manager had not informed the CQC about one safeguarding concern and an incident that was reported to the police as required by law. The failure of not notifying the CQC of such incidences without undue delay is a breach of regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations 2009. We are considering taking action against the provider for failing to meet regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People were protected from harm and abuse. Staff received training and understood their role in relation to safeguarding people. Safeguarding had been discussed with people in tenants’ meetings and written about in the service’s newsletter. Tenant’s meeting was the term used at this service for the meetings attended by people who used the service. Therefore, we have used this term throughout the report.

The service provided safe care and support to people who used it. Risks to people’s health and wellbeing had been assessed and staff had guidelines on how to support people safely. The service had a system in place for the management of medicines and people were supported to take their medicines safely and as intended by the prescriber. The service dealt appropriately with accident and incidents and actions were taken to reduce the possibility of them reoccurring. Appropriate recruitment procedure ensured people were protected from unsuitable staff.

People’s needs and preferences were assessed prior to them moving into the service. There was a comprehensive assessment process, which involved people, which ensured that people received support that met their needs and personal preferences.

People were cared for by staff who received appropriate training and support from their managers. Staff skills were regularly assessed to ensure they knew how to support people in a safe and effective way.

The service helped people to live a healthy life. Staff supported people to have a nutritious diet that met people’s needs and preferences. When people’s health needs changed staff ensured people had access to respective external health professionals and services.

The service had worked within the principles of the Mental Capacity Assessment 2005 (MCA) and staff sought people’s consent before supporting them.

There was a peaceful atmosphere at the service and staff who supported people behaved in a kind and caring way. People told us they felt looked after by staff at all times.

People said they were involved in planning and reviewing their care and they had their say in how this care was provided. When people had any complaints about the service provision, the management team had dealt with these complaints promptly and to people’s satisfaction.

People, staff and external social care and health professionals spoke positively about the management team and how they thought the service was led.

The management team had systems in place to monitor staff performance and various elements of the service provision. Regular audits helped to identify any gaps in the service delivery. Actions were taken by the management team to ensure good quality of the care and support at all times.

At this inspection we sought to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The people we spoke with who used the service had nothing but praise for how well they were treated by staff. One person told us 'oh yes I trust them' and another said 'staff are lovely, I think they are wonderful and look after me so very well.'

At the time of this inspection there were no safeguarding concerns. It was the policy of One Housing Group Limited, the service provider, to annually review safeguarding concerns across the service to identify if there were any wider lessons to be learnt from the types of concerns that may arise.

Staff said they had training about protecting vulnerable adults from abuse and were able to describe that action they would take if a concern arose. It was the policy of One Housing Group Limited, the service provider, to ensure that staff had initial training which was then followed up with periodic refresher training.

During our visit we talked with staff about their understanding of the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff demonstrated a knowledge and awareness of both of these areas, as well as knowledge of where to seek specialist advice whenever needed. Staff were also aware of the recent Supreme Court ruling which affects the range of issues covered by MCA and DOLS assessments. It was positive to note that action had already commenced to review the likely impact of the ruling for people who used the service.

Is the service effective?

The people who were using this service each had a personal care plan. We looked at the care plans for three of these people and also spoke with each of them. The care plans covered personal, physical, social and emotional support needs. Although not everyone could recall the exact details contained in their care plan each person told us about the support and care which they received. We found this matched what had been written in their care plans and the agreed care and support that the service was required to provide.

The staff team also kept care planning records on a computer database which alerted staff to the date on which each care plan required a review. We found that care plans were updated at regular intervals and any new information that needed to be included, for example if a person's health care needs had changed.

Is the service caring?

People received support from staff in a variety of ways including personal care, shopping and help with domestic chores. The people we spoke with were highly complementary about the way in which the service supported them. One said, "Staff are in and out of my flat all the time helping me and I know I can call on them at other times if I need to.' Other people told us that they were very satisfied with their care and one said ' it feels like I am a member of a big family here.'

The manager showed us a new form of care plan agreement that had been recently introduced. We were told that this was designed to take the main points of the care plan and put it in a shorted version to make it easier to read and refer to rather than the full care plan documents. We looked at examples of these agreements and found they described in clear terms what people could expect from staff and how their care was to be provided. People had signed their agreements to show they agreed with the care the service provided.

Is the service responsive?

People's religious, cultural and personal diversity was clearly recognised by the service. When we asked the manager to describe examples of what steps the service took to promote this we were given an example of someone who recently asked for support from the service to discuss their lifestyle choice with people they knew.

The provider asked a sample of people to complete a questionnaire each month. We looked at eight surveys which were carried out in April 2014, all but one of which had been completed and returned. The comments people made were almost all highly positive. One person had raised a concern about a personal matter rather than a concern about the service. Their keyworker had then met with them to discuss this in more detail and to look at ways of helping them to deal with their concern. This showed that the service took comments which people made seriously and sought to address these speedily.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. None of the people we spoke with said they had had ever felt the need to make a complaint. One person said specifically *I can tell them if I had a complaint, I have no worries about doing that.'

Is the service well-led?

Staff we spoke with spoke positively about the range of training opportunities available to them. The provider kept records, which we viewed, showing which training staff had completed, when refresher training was due in core skills and plans to include additional training in specialised areas, for example, dementia and the Mental Capacity Act. Almost all permanent care workers were qualified to National Vocational Qualification level 3 in health and social care.

When we asked staff about supervision meetings with their line manager we were told that mostly these took place approximately every four to six weeks, which we saw on the supervision records we looked at. Staff supervision was more frequent than had previously occurred. We asked about what staff would do if they needed to speak about any issues in between these meetings and everyone told us that they could approach their line manager or other senior staff at the service. The manager told us that this year's round of staff appraisals for this year was due to take place shortly.

The manager told us that the provider carried out a quality monitoring process every three months. This process included a meeting with the London Borough of Camden Social Services Department who solely purchased the service from the provider. The results showed that residents' meetings were now being held each month with approximately half of the people using the service in attendance. This is an improvement on what we found at our previous inspection and the manager told us the service was reviewing how to encourage more people to attend regularly.

People using the service had varying needs. Most received support with personal care, domestic chores and cooking. Those we spoke with were all very positive about the care and support they received. One said, 'I'm very happy here. The workers help me a lot.' Another told us that the care provided met their needs, 'completely.' They said the care workers were friendly and one said they were 'very kind.'

As the acting manager showed us around the property, including the communal areas, we saw positive, warm and friendly interaction between staff members and people living there.

Paper records relating to people's care were generally well-maintained and easy to work with. However, staff had some difficulties making full use of the provider's computerised records system. People's care plans and risk assessments were regularly reviewed and updated to ensure their continuing needs were met. Members of staff were appropriately qualified and experienced and we saw that regular refresher training was provided, although there were some gaps noted.

There were systems in place for monitoring the quality of the service, including conducting service user surveys.