Apna Ghar Residential Home

Apna Ghar Residential home is a residential care home providing personal care to up to 3 people. The service provides support to people from ethnic minorities with their mental health. At the time of our inspection there were 2 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Risks to people had not been assessed and mitigated, for example exposed radiators or if window restrictors were required. Risks to the use of oxygen had not been assessed or mitigated. Some people could display high levels of anxiety, there was no guidance in place to inform staff how best to support the person during times of distress. When incidents occurred de-briefs with staff and learning was not always shared. Staff did not always have the training, skills and experience needed to de-escalate people’s distress. Staff recruitment processes were not always robust.

Medicines management was not always safe. Medicine stock did not match the numbers indicated on the medicine administration records. Staff had not completed medicine competencies.

The provider had not completed any checks or audits on the service to seek to improve it or identify any areas for improvement. There was a lack of oversight in relation to medicines management, recruitment, training and risk management.

Staff understood their requirement to protect people from the risk of abuse. The service was clean and well maintained. Staff had received training in infection control.

People were supported to have maximum choice and control of their lives and staff supported /did them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

The provider had not engaged in any forums to share knowledge or provide joined up care for people. However, people had been supported to attend healthcare appointments such as visiting the GP and dentist.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Rating at last inspection

The last rating for this service was good (published 8 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Apna Ghar Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines, risk management, recruitment and good governance this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Apna Ghar is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides specialist support for three Asian adults who have mental health difficulties.

At our last inspection on 1 March 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

Staff recognised the signs of abuse or neglect and understood their role and responsibilities to report any concerns so they could be acted on. Checks were carried out on new staff to make sure they were suitable to work with people who needed care and support.

Risk assessments were in place and to identify risks to people and staff knew how to manage risks appropriately.

Staffing levels had been maintained to ensure there were enough staff available to meet people’s physical, social and emotional needs. Staff were suitably trained and received regular supervisions so that they had the knowledge and skills to meet people's needs.

Safe medicines management processes were in place and people received their medicines as prescribed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the service complied with these requirements.

Staff continued to encourage people to undertake activities and supported them with their independence.

People continued to experience care that was kind, caring and personalised. Staff knew the people they were supporting well, including changes in their behaviour which indicated that their mental health maybe deteriorating. People had access to health care professionals to make sure they received appropriate care and treatment.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

The registered manager was approachable and the atmosphere in the service was relaxed and informal. They were supported by a staff team who understood the aims of the service.

Further information is in the detailed findings below.

Apna Ghar is a privately owned care home which provides accommodation and specialist service in a homely environment to three Asian adults who have mental health difficulties. The people who used the service needed support to understand their particular conditions; identify triggers for relapse; and learn coping strategies. At the time of our inspection, the people who lived in the home were fairly independent, hence requiring minimal support.

There was a registered manager at the home. 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.

People were protected against the risk of abuse. People told us they felt safe. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs such as mental health, and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient numbers of staff to meet people’s needs. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

Staff were recruited using procedures designed to protect people from unsuitable staff. Staff were trained to meet people’s needs and they discussed their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

Safe medicines management processes were in place and people received their medicines as prescribed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

Staff were aware of signs and symptoms that a person’s mental health may be deteriorating and how this impacted on the risks associated with the person’s behaviour. People were supported as appropriate to maintain their physical and mental health.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the Commission.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe. One person said, 'I feel safe here, it's my house'. Safeguarding procedures are robust and staff understood how to safeguard the people they supported.

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

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

Specialist dietary needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

Is the service caring?

The home provided a specialist service in a homely environment to three Asian people. The people were appreciative of the cultural and spiritual support they received at the home. People told us this was a lovely place to live and that they were well supported by the provider. People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. The result stated that people were generally happy with the service provided. We saw comments such as 'I am happy with care received by my sister, I have no complaint'.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People knew how to make a complaint if they were unhappy. For example, one person said, 'If I have a problem, I will talk with the manager and she will listen'.

Is the service well-led?

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We spoke with one person who used the service about their experience of living in the home. They told us that they liked their home. They commented "I like it in this home'. 'I am happy here' and it's alright'.

Appropriate arrangements were in place in relation to obtaining medicine and the recording of medicine. Medicines were kept safely.

There were enough qualified, skilled and experienced staff to meet people's needs.

People who used the service, their representatives and staff were asked for their views about care and treatment that was provided and their opinions were acted on.

People were given support by the provider to make a comment or complaint.

The provider told us they always ensured that they carefully assessed the care and support needs of people living in the home. People, their relatives or representatives' and health care professionals, where necessary, were involved in this process.

We observed that care and support was delivered with warmth, kindness and dedication. The relationship between the staff/ owner and the people who lived there was good and personal support was provided in a way that promoted and protected people's privacy and dignity. People we spoke with told us that the staff were 'kind and friendly'.

The arrangements for keeping the home clean and tidy were satisfactory. The standard of the accommodation, d'cor and furniture and fittings were good and provided a clean and comfortable place to live.

Records showed that staff were recruited safely and relevant checks were completed before they started work.

We saw there was a complaints procedure in place but that this was not in a user friendly format that met people's needs.