Background to this inspection
Updated
20 November 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 was planned to check 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 inspection took place on 5 October 2018 and was announced.
We gave the service 48 hours’ notice of the inspection visit because it is a small service and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.
The inspection was carried out by one inspector.
Before the inspection, the provider completed a Provider Information Return (PIR). 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 reviewed the information we already held about the service which included notifications. A notification is information about important events which the service is required to send us by law.
We viewed two care records and associated risk assessments, three staff files including their recruitment and training and supervision records. We also reviewed various meeting minutes, policy documents and audits relevant to the management of the service.
We spoke to two people who used the service, two support staff, the registered manager and one relative. We sought feedback from the local commissioner after the inspection.
Updated
20 November 2018
The inspection took place on the 5 October 2018 and was announced.
At our last inspection on 29 August 2017 the service received an overall rating of 'Requires Improvement'. We identified four breaches of the regulations relating to safe care and treatment, fit and proper persons employed, staffing and good governance.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive and Well- Led to at least good. At this inspection we found the provider had made the necessary improvements to meet the standards required of them.
Nimrod House provides care and support to people living in a supported living setting. Each person’s flat had a living area, separate bathroom and kitchen. People live in their own flats so they can live as independently as possible. People's care and housing are provided under separate contractual agreements. The Care Quality Commission does not regulate the premises used for supported living; this inspection looked at people’s personal care and support.
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.
People had risk assessments in place and now clearly stated how to mitigate against risk. Staff supported people to take risks in a safe way so that their freedoms were respected. Relatives told us their family members were kept safe at the service by staff.
Staff understood the different types of abuse and how to report abuse if they suspected it. Staff also knew when to whistleblow if they witnessed poor practice.
Staff were recruited safely and relevant checks were performed to check for suitability before staff could work with people at the service.
People’s medicines were managed safely and the registered manager regularly checked staff competency in medicine administration to ensure safe practice.
The risk of infection was minimised as staff were provided with personal protective equipment and they kept people’s living areas clean and tidy.
People’s needs were assessed before they began to use the service and people were involved in the care planning process along with their relatives and health professionals. People’s care plans were person centred and people were given the opportunity to speak with their key worker each month to discuss their care.
Staff received mandatory training and specialist training in Autism and diabetes, specifically related to the people they supported which ensured they received good care from staff who understood their health needs. Staff were supported by management and received regular supervision and an annual appraisal where appropriate.
People were offered choices and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) Where needed the registered manager had made appropriate applications to the Court of Protection where people’s liberty was being deprived.
People’s dietary and food preferences were now clearly recorded, people were supported to eat and drink well. People were supported to access health services to maintain good health.
People were supported by staff who were kind and patient. We observed people laughing and dancing with their key worker. People’s privacy and dignity was respected. People were supported to explore personal relationships.
People took part in a number of activities of their choice and records showed people suggested new activities they wanted to try.
The registered manager had an open-door policy and staff felt well supported by management and other staff at the service.
The registered manager had a variety of monitoring tools they used to check the quality of the service. The service sought feedback from people who used the service via people’s key worker sessions and feedback from relatives and health professionals. The service now held a quarterly coffee morning to provide people’s relatives with a forum to discuss their family members care and any other matters.