Archived: Ponderosa House

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.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

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

Is the service caring?

We saw that people were supported by kind and attentive staff who displayed patience and gave encouragement when supporting people. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required. People told us that they were happy with the care and support they received from the service. One person said, "I like it here" and "I like the staff, they help me make my bed." One person's relative said, "'X'is looked after very well indeed. There is nothing that I could say or pinpoint that is wrong."

People told us they pursued many activities and this was evident during our inspection. Some people were supported with community based activities and to attend social events. This showed that the provider promoted people's community involvement and well-being.

The provider promoted people's independence as much as possible. People told us that they felt respected and their privacy and dignity was maintained at all times by staff.

Is the service responsive?

People's care needs and any potential risks that they may be exposed to were assessed before they received care and support from the provider. Records showed that keyworkers had regular meetings with the people they cared for to discuss what was important to them and any goals and aspirations they may have. The provider reviewed people's care records regularly and made amendments to documentation as people's needs changed to ensure they remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as occupational therapists or doctors, they were supported by staff to arrange this as independently as possible and to attend scheduled appointments.

People told us they felt included in decisions made about their care and they made choices in all aspects of their lives and our findings supported this. Documentation showed the provider gave people information about their care choices and about the service they should expect to receive. This showed the provider was inclusive and responded to people's preferences.

There was an effective complaints system in place and when we reviewed complaints that had been received in the service, we could see that these had been handled thoroughly.

Is the service safe?

People were supported by staff to live in safe, clean and hygienic environments within their own homes. There were enough staff on duty to meet people's needs and a member of the management team was available on call for support and in the event of an emergency. Records showed that staff were appropriately trained to ensure that they were equipped with the correct skills and attributes to carry out their jobs effectively and safely. Documentary evidence showed that health and safety checks were carried out within people's homes regularly to ensure that they remained safe within their environments.

People's care needs had been assessed and their care records showed that risk assessments were in place to reduce the chances of them coming to any harm, whilst living their lives as independently and fully as possible. For example, we saw that where people were at risk of injury whilst bathing, this was clearly highlighted in their care plans and risk assessments.

We reviewed the safeguarding policy and procedures in place to address and manage incidences of a safeguarding nature. We found that these arrangements were both appropriate and safe. Records showed that staff had received training about safeguarding within the last year. Staff and management were able to give us examples of different types of harm and abuse, and they confirmed how they would report and progress any safeguarding matters brought to their attention.

Is the service effective?

People told us they were happy with the staff who cared for them and they met their needs. One person said, "I like the staff." Another person told us, "I think they do look after me really well. The staff are very nice." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

Certificates were available that showed staff had received appropriate and up to date training to meet people's needs effectively.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Care managers we spoke with told us they were confident that the provider delivered a good care service and they kept them updated and fully informed of any changes in people's care needs.

An effective quality assurance system was in place which was successful in identifying shortfalls. Records showed that these shortfalls were promptly addressed. We saw the provider learned from accidents, incidents and safeguarding matters, and in each case these were reviewed and where necessary follow up actions were allocated to managers to pursue. Wherever necessary, the provider had introduced measures and amended care plans and risk assessments to prevent repeat events.

Staff told us they were clear about their roles and responsibilities. The provider had a range of policies and procedures in place which gave direction and instruction to staff. Staff and management meetings were held on a regularly basis. These addressed the standards of care delivered within the service and analysed the effectiveness of the operating systems in place. We saw that the provider acted on issues raised from these meetings in an attempt to achieve ongoing continuous improvement. This helped to ensure that people received a good quality service at all times.