Archived: Co-operative Terrace

We previously inspected Cooperative Terrace in April 2014, at which time the service was compliant with all regulatory standards.

The service had 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 2008 and associated Regulations about how the service is run.

The person using the service told us that they felt safe with the support from the care staff. Policies and procedures had been recently reviewed and amended. There were safeguards in place to protect people from harm and to ensure staff understood their responsibilities.

Records were kept regarding incidents and accidents. These were investigated and reported on as necessary in a timely manner. Analysis by the registered manager was used to review care needs, risk assessments and implement preventative measures.

The service managed risks associated with the health, safety and wellbeing of the person who used the service, including carrying out regular checks of the premises and equipment in line with their legal responsibilities as the landlord. Individual care needs had been assessed for all aspects of the person’s life and we saw evidence which demonstrated this was reviewed and monitored regularly.

Medicines were managed safely and medicine administration records were detailed and accurate. Medicine was stored safely and securely. The staff followed strict guidance regarding the receipt, storing and disposing of medicine. All other records relating to the management of the service were well maintained.

We saw there were enough staff employed to manage the service safely and to meet the person’s needs. Staff files showed the recruitment process was robust and staff had been safely recruited. Training was up to date and staff had a mix of skills and experience. Opportunities were given to staff to progress their career and achieve qualifications in health and social care.

The directors of the company one of whom was also the registered manager took turns to carry out staff supervision and appraisals which were regular and recorded. Staff and relative meetings were also held regularly and minutes were noted. This demonstrated that everyone had the opportunity to speak to the managers and raise any issues. Competency checks were undertaken by senior care staff to assess the staff’s suitability for their role.

There was evidence to show the registered manager and staff had an understanding of the Mental Capacity Act (MCA) and their responsibilities. The service assessed mental capacity and reviewed it as necessary. Care records showed that wherever possible the person had been involved in making some decisions, but more complex decisions that were made in the person’s best interests’ had been appropriately taken with other professionals and a relative involved.

Staff supported the person to prepare nutritious, well-balanced meals. We observed the person enjoyed their food at mealtimes. The person had choice around mealtimes and often ate the planned meal from the menu, however we also saw evidence that they could choose different items if they preferred.

Staff displayed kind, caring and compassionate attitudes and the person told us all the staff and managers were nice to them. We observed the person was treated with dignity and respect and that the staff were pleasant and friendly.

The registered manager and staff had built a person centred care plan for the person using the service. Individual needs had been initially assessed and were constantly reviewed with the involvement of the person, their relative and external professionals. The care plan included life history, family members, interests and hobbies. These were accessible for the person to read and they included photographs and pictures.

The service encouraged and promoted activities which were indicative of the person’s hobbies and interests. The activity programme was built by the registered manager and staff team to ensure the person remained included in their community, whilst the individual activity plan empowered the person to get involved in activities in which they showed a keen interest.

There had been no complaints received by the service since the last inspection. The registered manager kept a record for complaints and explained to us how the complaints procedure was managed. The person told us they had nothing to complain about but would feel confident to tell the staff or a manager if something was wrong. The registered manager also kept a record of accidents and incidents, which they regularly monitored.

Regular quality monitoring took place. The deputy manager undertook daily and weekly audits to ensure the quality and safety of the service. The registered manager oversaw these. The service asked staff and relatives for feedback and gave them the opportunity to do so. Surveys were issued annually to gain the opinions of staff and relatives about how the service was managed and how it could be improved. We saw a good response to surveys, which allowed the registered manager to collate the feedback and measure an overall opinion. We saw an action plan had been drafted to improve the service following the last survey.

The registered manager had an extensive employment history working with people who had a mental health condition and she was well established in her role, having known the person for many years. The staff team were also consistent. Staff told us they felt valued and that they enjoyed working at the home. A staff member told us, “I like working here; I have good interaction with (person)”. And “I have been treated well and fair, I feel valued and they help me work my shifts around my kids – they try to accommodate you”.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' 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 the person who used the service, their relatives, 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?

We spoke with a relative who told us they felt the home was safe and the person who lived there was well cared for.

Safeguarding procedures were robust and staff had been trained on how to safeguard the person they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve.

Care records contained risk assessments and how these risks should be managed. These were signed by a relative. For example, travelling by car, walking in the community, bowling, eating out, boredom and frustration. There were guidelines for the staff on preventative strategies for certain situations. Staff had signed to confirm they understood the risk assessments for the person.

There was a system in place to ensure people's money was safe and any expenditure was appropriately recorded.

The home had policies and procedures in place related to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to help ensure people were appropriately assessed and to make sure that the person was looked after in a way that did not inappropriately restrict their freedom. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We saw the premises were safe, clean and suitable to meet the needs of the person who lived there.

There were policies and procedures in place to ensure medicines were safely stored and administered.

Is the service effective?

The person's health and care needs were assessed and care plans were developed with them and their representatives. The care plans provided staff with information about how the person's care needs should be met. Guidelines were in place to inform staff of the actions to be taken in certain situations and these were monitored by the manager.

The staff we spoke with were able to describe the individual needs of the person they cared for and how these needs were met.

The service worked well with other agencies and prompt referrals were made to health care professionals which helped ensure the person's health care needs were met.

Is the service caring?

A relative told us they had been involved in the care plans and were kept informed of any changes. Comments included, "I have meetings with the staff. I like all the staff, they know X very well and they can anticipate his mood."

We observed good relationships between the person who used the service and the staff on duty. For example, the person was being supported to do their food shopping at a local supermarket.

The staff told us they had received appropriate training to meet the individual needs of the person they cared for.

Is the service responsive?

We saw evidence to show that the complaints procedure had been explained to the person who lived at the home. A relative told us they knew how to make a complaint but had never needed to. They said they felt confident that if they did complaint it would be taken seriously and fully investigated.

The person who lived at the home were asked their opinion of the service and what they would like to change. A relative told us, "They always ask X for his opinion about things and they keep in touch with me." They confirmed they were issued with a survey once a year but they had never made any negative comments.

Is the service well-led?

The provider had systems in place to monitor the quality of the service the person received.

We saw records to show the deputy manager from another service owned by the provider was responsible for monitoring care records, incidents, petty cash, risk assessments, food hygiene and diet management on a weekly basis. The manager audited these each month and carried out an audit on the medication system to ensure standards were being maintained and any improvements were implemented.

Staff told us they were clear about their roles and responsibilities. Comments included, "The manager is always available if I have any issues and she is very approachable."

We saw the person's care records were monitored regularly by the manager to ensure appropriate action was taken if there were any concerns. For example, incidents were analysed monthly and preventative strategies were in place.

Relationships between the person and staff were clearly good. The person and their relative told us, and we saw in practice staff treated the person with respect and helped them to remain as independent as possible.

We found that the person's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The person's relative was positive about the care and support provided.

The home was clean and we saw there were effective systems in place to reduce the risk and spread of infection.

We concluded that the person, staff and visitors were protected against the risk of unsafe or unsuitable premises.

We saw that there were suitable numbers of skilled, trained and experienced care staff. The person's relative told us, 'I don't have to visit every day to know everything is alright. I'm happy he's safe with the staff.'

We found that the person's personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.

Relationships between the person and staff were clearly good and we heard good natured exchanges of conversation during our visit.

The person told us they were 'extremely happy' living there and when we asked about staff, the person said, 'They're lovely, I like them all.' We asked the person if they felt safe living there and they told us, 'Yes, I feel safe. If there's anything wrong, there's my phone, I would dial 999.'

We spoke with a close relative of the person who told us, 'They've got a good team together, they care for X and they are looking after X's diet well. I am truly pleased.' The relative also told us, 'If I had any concerns I could just say so and they would sort it. I can tell carers or make suggestions anytime.'

We viewed care records and found they contained relevant information to enable staff to care for the person properly.

Staff we spoke with had a working knowledge of safeguarding matters and we found that safeguarding policies, procedures and information were available at the service.

We found that staff were supported to deliver care and treatment safely and to an appropriate standard. Staff told us this was the case, and we saw documentary evidence which supported this.