Archived: Ponderosa House

Updated 4 August 2016

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 6 and 13 May 2016 and was announced. The provider was given 48 hours’ notice because the location provides care to people in their own homes who are often out and about during the day. We wanted to be sure that someone would be in.

The inspection was carried out by one inspector. We spoke with six people who were supported by the service during our inspection, including one person by telephone. We spoke with one relative who we contacted by phone following our inspection. We spoke with local authority contracts and safeguarding officers. They told us that they were not aware of any concerns about the service, and there were no on-going safeguarding investigations.

We spoke with the registered manager, two other service managers, and a deputy team leader. We also spoke with the administrator and six care workers during our inspection.

We reviewed six people's care records. We looked at a variety of records which related to the management of the service such as audits and surveys. We also checked records related to the safety and maintenance of the premises and equipment and viewed electronic records of accidents and incidents.

Prior to carrying out our inspection, we reviewed all the information we held about the service. We did not request a provider information return (PIR). A PIR is a form which asks the provider to give some key information about their service; how it is addressing the five questions and what improvements they plan to make. We also looked at notifications submitted by the provider in line with legal requirements.

Updated 4 August 2016

Ponderosa House is the local office base of a service which provides personal care and support to 47 people in 14 properties in the Newcastle, Northumberland and North Tyneside areas. A day centre is located below the office but we did not inspect this facility as it was beyond the scope of our registration regulations.

The inspection took place on 6 and 13 May and was announced.

A registered manager was in post who was supported by five "cluster" managers who each had responsibility for a number of services within the organisation. There were plans for the cluster managers to register with the Care Quality Commission and for the current registered manager to take on an operational management role. 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.

There were safeguarding policies and procedures in place and staff knew what action to take if abuse was suspected. They had received training related to the protection of vulnerable adults. There were no ongoing safeguarding concerns at the time of our inspection and this was confirmed by the local authority safeguarding adults officer.

Robust systems were in place to support people to manage their finances safely. This meant that people were protected from potential financial abuse.

Risk assessments were carried out to ensure that people were protected whilst supporting them to remain as independent as possible. These included risks related to people’s physical and psychological health, and assessments were reviewed regularly. Accidents and incidents were recorded and acted upon appropriately. Safety checks to the building, premises and equipment were carried out.

Medicines were managed safely. Procedures for the safe administration of medicines were in place and regular audits were carried out. People were supported to make choices about their medicines and information was available to them in an easy read format.

Safe recruitment processes were followed and people who used the service were involved in the recruitment of new staff. Suitable numbers of staff were on duty on the days of our inspection but relatives, staff and a visiting professional expressed concerns about the numbers of staff who had left the service in recent months. We found that recruitment had taken place and there were plans in place for the further recruitment of staff. We have made a recommendation to monitor staffing levels in light of the number of comments made.

New staff received an induction into the service and regular training was provided. Staff received regular supervision and appraisals from their line manager.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The registered manager had submitted DoLS applications to the local authority for authorisation. Capacity assessments were carried out, and decisions taken in people's best interests were appropriately recorded.

The health needs of people were met. We saw people had accessed a range of health services and hospital passports were provided to NHS staff who cared for people who used the service. These provided information about people’s needs and how they preferred these needs to be met whilst in hospital.

People were supported with eating and drinking, and the level of support they needed was assessed and provided. There was an emphasis upon choice and independence around mealtimes, and healthy eating was also promoted. Allergies and special dietary requirements were recorded and catered for.

People were supported by staff to maintain cleanliness levels within their own homes. Assistive technology was used to support people if needed. Independence was promoted and staff treated people with kindness and respect. People told us they felt well cared for and we saw that they had good relationships with staff.

Care plans were personalised, detailed, and were reviewed monthly. People were involved in the care planning process. Specialist care plans such as those to support behavioural needs were in place and advice sought where necessary. The service operated a "Fusion Model" of support. This meant that the provider sought to bring together the best possible resources and interventions to provide an optimum level of care to people. An electronic [computer based] record of care and treatment was used in one service and this helped to identify any gaps in the level of support provided to people based on an analysis of their needs.

People had access to a range of activities and were supported to maintain their hobbies and interests. They attended clubs and organisations which catered for their specific interests.

A relative, staff and a visiting professional spoke highly of the manager and team leaders. Staff felt well supported and the registered manager felt listened to and supported by the wider organisation. There were plans for five cluster managers to register with CQC, and for the current registered manager to take on an operational management role. Some staff felt uncertain about how this might affect them in future but there were regular meetings held to support staff during this time.

Meetings with people, staff and managers took place on a regular basis. Quality assurance systems were robust and regular audits of the quality and safety of the service were carried out locally and by staff from head office.

We looked at notifications sent to CQC. We found one incident which had been dealt with appropriately by the registered manager but had not been notified to CQC in line with legal requirements. We clarified which incidents must be reported and the registered manager confirmed their understanding of this. They assured us that we would be notified of all such incidents in future.