Background to this inspection
Updated
17 April 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.
An inspector and their inspection manager carried out the inspection. It took place on two dates 18 and 30 January 2018. The first inspection was unannounced, the second announced. The inspection was undertaken in two parts to inspect the different parts of the service.
The first day we inspected the residential service. We visited the three bungalows. We spoke with five care staff, the two managers who were waiting for their CQC registration as well as the registered manager and the regional manager. We met people using the service but our communication with them was limited due to the nature of their disability. We carried out observations at lunch- time and observed different activities throughout the morning. Some people were out throughout the day attending planned activities. We looked at three staff records, accessed training, and supervision schedules. We looked at medication arrangements in one of the bungalows and looked at audits, the medication policy and medication training. We took a copy of notifications and followed up safeguarding concerns and incidents. We took a copy of the statement of purpose, which was not person specific but generic. We reviewed minutes of meetings and feedback from people. We looked at four support/care plans as well as other records associated with people’s care.
On our second day, we inspected the supported living service we have tried to report on separately within the report. We spoke with the deputy manager, the acting manager and four care staff. We spoke with four people when we visited them in their flats. For each person we visited we looked at care records and arrangements for people’s medication and finance. We also looked at records for accidents, incidents, safeguarding concerns, and audits.
Before the inspection, we reviewed information we already held about the service including notifications, which are important events the service is required to tell us about. We also used information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least annually to give some key information about the service, what the service does well and improvements they plan to make.
We spoke with the local authority safeguarding team, the local authority quality monitoring team and a number of health care professionals. We received communication from relatives about the service. We also viewed a number of ‘Share your Experiences’ forms, where people have used our website to provide feedback.
Updated
17 April 2018
The inspection took place over two separate dates. The first date on 18 January was unannounced but we arranged with the provider to come back on a second day to inspect the second part of their service. This took place on 30 January 2018. The provider is registered for both residential care and supported living, which comes under the umbrella of two regulated activities but under one location. The last inspection to this location was 19 December 2016 and 05 January 2017. At this inspection the service was rated as requires improvement in 3 out of the 5 key questions we inspect against. We identified one regulatory breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was for regulation 17- 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 service in relation to the improvements and identified breach of regulation. This was provided when requested.
Fryers Walk provided two separate services. It was registered as a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There were fifteen people living in three bungalows called Poppy, Daisy and Foxglove. All bungalows were staffed separately around people’s individually assessed needs. In addition to the bungalows, there were offices on site for staff to use.
Fryers walk also provided care and support to fourteen people living in supported living settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the inspection, they were supporting eleven people with personal care. Some people lived by themselves and some lived with others who may or may not receive a regulated care service. The accommodation was owned and managed by a housing association.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Registering the Right Support CQC policy.
The service had a registered manager at the time of our inspection. 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.
However, the registered manager was in the process of leaving to take over the responsibility of another Mencap service. The service had appointed new managers who were not yet registered with CQC. They were sufficiently experienced and working alongside the existing registered manager. They were going to oversee the residential service with one manager overseeing two residential bungalows and the other manager the third bungalow. There was also a deputy manager for the residential service but they were off sick at the time of this inspection. In addition to the residential managers, another manager was employed and had applied for registration for the supported living service and had a date with the CQC for their interview. An experienced deputy manager supported them. The managers were well supported by the regional manager who was at the service each week.
The service was mostly well led and improvements had been made since the last inspection. The service was in the process of registering new managers with CQC. The managers had received a good induction into their role. We found that the services were managed separately and there was not clear communication across each site. We found some parts of the service ran more effectively than others and this made it difficult to assess if everyone using the service were getting good outcomes. For example, some people had regular opportunities to go out, others less so. Some people’s records clearly demonstrated people’s wishes and aspirations, other people’s records did not. Some people living independently did not have sufficient opportunities to influence the service they received such as what staff would support them with and having access to their own medication and bank account.
However, we found overall the service was working hard to support its staff and were quick to identify any concerns about staff practice and ensure staff were supported to improve. Staff spoke with were motivated and passionate about what they did. The use of agency staff did not detract away from the level of service provided and agency staff sometimes took permanent contracts.
Risks were mitigated as far as possible and there were appropriate quality assurance systems, which took into account people’s experiences and learnt lessons from incidents, accidents and any potential risk. Records were not always complete showing actions taken and this was an area for improvement
Staffing levels were adequate and vacant posts were being recruited into. The service had robust recruitment processes in place to ensure they recruited the right staff. There were good processes in place to support existing staff and help improve staff retention. The use of agency staff was kept to a minimum but still necessary to ensure the service was not understaffed.
Risks to people’s safety were mitigated as far as possible and records recorded the actions staff should take to keep people safe. Regular health and safety checks helped to ensure the environments were free from risk as far as possible. We looked at people’s environments in relation to the residential service but our regulations do not require us to do this in the supported living service. However, individual risk assessments were in place for both and covered peoples individual’s behaviours and needs and their environments. Accommodation was suitable for people’s individual needs and was on one level with appropriate equipment to support people’s manual handling needs and sensory needs.
Staff knew how to and felt confident that they could recognise abuse and knew what actions to take to report it. The records in the service were inconsistent with regards to safeguarding concerns and incidents. For example, records we had asked for had been archived and there was not clear documentary evidence of actions taken. However, the provider was able to provide this information and has changed their practice to ensure information is more clearly documented in future.
Staff were trained to administer medication and there were clear protocols around this. Any errors had been identified and acted upon because there was robust auditing and staff were supported to improve their practice. However, in the supported living service audits did not help us to identify which medication records had been looked at and we thought it would be clearer to carry out separate audits for each dwelling.
The service supported its staff to develop their professionalism and work in line with best practice. Staff new to the service completed a recognised foundation course and mandatory training suitable to their role. Staff were well supported and their performance monitored to help ensure high standards were maintained.
People were supported to eat and drink enough for their needs. There had been some improvements in this area after a number of concerns were identified. Staff had received training in nutrition and the service had established better links with the dietician and speech and language team.
Links with health care professionals were well established for the benefit of people and to ensure their needs were met as holistically as possible.
Staff understood and effectively applied the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards as applicable depending on the type of support they provided. People can be deprived of their liberty if lawful and only after approvals from the Local Authority. However, this only applies to residential care and not supported living services. People were involved in decisions about their care so their human and legal rights upheld. People had maximum choice and control of their lives and staff assisted them in the least restrictive way possible.
Staff were caring. They supported people according to their needs and wishes and where possible promoted people’s independence.
People were supported to achieve their goals although it was not clear from each person’s record if these had been identified.
People were consulted about their care needs and communication plans told us how staff communicated with people and took into account any sensory needs they might have.
The service was responsive and people’s support plans were detailed. However, more work was needed to be done to ensure people’s records showed what progress people were making towards an agreed goal or wishes.
There was an established complaints procedure and the service took account of any feedback it received about the service.