When we inspected this service in January 2014, we told the provider they must take action in relation to a number of issues. We also issued a warning notice in relation to how the provider assessed and monitored the quality of their service. Our concerns included issues arising from lack of monitoring and audits to ensure peoples safety, lack of correct safeguarding procedures, the registered person had not had regard to the complaints and comments made, and views expressed, by service users, and those acting on their behalf. There was also a failure to regularly seek the views of service users, persons acting on their behalf and a lack of adequate information in a number of records relating to people who used the service.The provider provided an action plan as to how they were going to address the issues and said that all actions would be completed by the 30 March. Due to the level of our concerns at the last inspection we re-inspected soon after this date in order to see if progress was being made. We found that improvement had been made.
We inspected this service over two days. On both days of our inspection the manager was not available and the newly appointed support coordinator had also been off but had returned by the second day of our inspection. The service was being managed by a care coordinator and service managers from other services.
There were ten people living in the two bungalows that make up this service during our inspection. We communicated with six people, and reviewed six people's support files. We also spoke with eight care workers, support coordinators and senior managers and reviewed documents provided to us by management. We also spent time walking around both homes and conducted two SOFI observations.
We considered our inspection findings to answer questions we always ask;
Is the service safe, caring, effective, responsive and well led?
This is a summary of what we found '
Is the service safe?
People were not completely safe from avoidable harm, although improvement's had been made since our last inspection. People we communicated with felt safe and their needs were well documented within care files. However the needs documented, and how these needs were to be met, did not always reflect the most recent recommendations made by healthcare professionals. For example, guidelines in people's epilepsy and rescue support plans were not always being carried out because staff were not always aware of the most recent guidance that had been provided.
Support coordinator audits had been introduced by the manager to ensure information about people's needs was being exchanged between staff effectively. However, we found this system had not been delegated in their absence which meant that people's safety could not always be assured.
Environmental audits included health and safety checks. We found that a number of issues regarding the safety of the environment had been identified through a recent audit and were in the process of being resolved to ensure the safety of the premises and people within it.
We reviewed newly updated safeguarding protocols that clearly documented what to do if people were being harmed or if abuse was suspected.
Is the service caring?
Piggy Lane provides a caring service which is delivered by care workers who showed warmth, compassion and respect for the people they supported. Care staff understood the needs of people they supported and involved other professionals when necessary. People we communicated with felt cared for. One person told us, 'the staff are nice, they care about me, they know what I like'. Other people, who could not communicate verbally, indicated they felt cared for by smiling and/or by their hand gestures. People were supported to maintain appropriate health checks such as visits to the dentist, and were also supported to access the community and maintain an active social life. Over the two days of our inspection we observed that people attended friendship groups and witnessed people going on shopping trips and visiting museums.
Is the service effective?
We found that improvement had been made since our last inspection, but the service was still not always effective. We found that care workers were effective and identified peoples changing needs. However we found the system for ensuring that new information was recorded in care plans and exchanged between staff was not effective and had the potential to put people at risk.
We found that staff received training to meet people's needs and that a central system highlighted when updates were required. We found that more robust systems of auditing quality and safety had been introduced. However, these systems were in their infancy and were not yet sufficiently effective at the time of our inspection.
The care people received meant that positive outcomes were being achieved as people were being supported to maintain an active social life. People were also encouraged to participate in the day to day running of the home and encouraged to make their own choices.
Is the service responsive?
This service was responsive. Care workers we spoke with felt that since the last inspection communication had improved and issues raised were responded to quickly and sufficiently. One care worker said, 'things are so much better, I feel I can go to the office and ask a question knowing I will get a response'. Another care worker told us, 'it has been nice knowing when I raise an issue for a resident regarding their health, I get the support I need'.
We found that when peoples care needs changed the service responded to ensure those changing needs were met. This meant that people were supported by people who were responsive and alert to their changing needs to ensure people wellbeing.
Is the service well led?
We found that positive changes had been made but the service was still not always well led. We found there had been improvements in the leadership and overall culture of this service since our last inspection. Senior managers we spoke with had a clear understanding of the risks in their service and we saw evidence of audits and follow up that improved the quality and safety of the service. However on the day of our inspection key staff were absent and had been for some time, interim arrangements had been made to ensure the service was supported. This had prevented the full implementation and evaluation of the systems designed to improve the quality and safety of the service being provided. Despite managers having an awareness of risks, some areas had not been addressed. Staff we spoke with felt the leadership was clearer and that communication had 'improved dramatically'. Staff also felt they could raise concerns freely without fear and that their feedback was valued. One person said, 'it's a completely different place to work, there is just a better feel about the place'.