Restoration Residential Care Home

Restoration Residential Care Home is a residential care home providing personal care to up to four people in one adapted building. The service provides support to people with mental health needs. At the time of our inspection there were four people using the service.

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

People were safe at the service. Staff knew how to safeguard people from abuse. Staff managed risks to people’s safety and wellbeing and understood what action to take to help keep people safe. The service was clean and hygienic. Staff followed current infection control and hygiene practice to reduce the risk of infection. The provider carried out regular health and safety checks of the premises and equipment to make sure these were safe. Medicines were managed safely. People were supported to take their medicines as prescribed.

There were enough staff to support people and meet their needs. The provider carried out recruitment and criminal records checks to make sure staff were suitable to support people. Staff were provided training to help them meet people’s needs. Staff were well supported and encouraged to learn and improve in their role. Staff enjoyed their work and supporting people using the service.

People were involved in planning their care and could state their choices for how this was provided. People’s records reflected their needs and preferences. Staff knew people well and understood how their needs should be met. The provider checked with people at regular intervals that the care and support they received was continuing to meet their needs and sought their views about how the service could be continuously improved.

Staff supported people to manage their healthcare and medical conditions and made sure people could access support from healthcare professionals when needed. Staff encouraged people to eat and drink enough to meet their needs and to maintain a healthy diet.

People were satisfied with the care and support they received from staff. Staff were kind and treated people well. They respected people’s right to privacy and to be treated with dignity. People were encouraged to be as independent as they could be with daily living tasks. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to undertake activities that reflected their interests and preferences. Relatives and friends were free to visit people without any unnecessary restrictions. The service had been designed and decorated to meet people’s needs and people had a choice of comfortable spaces to spend time in.

The service was managed well. The registered manager was experienced, understood how people’s needs should be met and had oversight of the service. They undertook checks at regular intervals, to monitor, review and improve the quality and safety of the service.

There were systems in place to investigate accidents, incidents and complaints and people to be involved and informed of the outcome. The provider worked proactively with healthcare professionals involved in people’s care and acted on their recommendations to deliver care and support that met people’s needs

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 January 2021). We did not look at all the key questions at the last inspection and as such an outstanding breach of regulation from a previous inspection (published 24 March 2020) remained. The provider had completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at a previous inspection.

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 effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Restoration Residential Care Home is a residential care home providing personal care to up to four people in one adapted building. The service specialises in supporting people with mental health needs. There were three people using the service at the time of this inspection.

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

The quality and safety of the service had improved for people since our last inspection. People’s records now contained current and accurate information about their assessed care and support needs. People were involved in making decisions and their records reflected their preferences and choices about how care and support was provided. There was now detailed information about identified risks to people’s safety and wellbeing. Staff understood these risks and what action to take to support people to stay safe. People’s records had been updated to reflect their communication needs and their wishes for the support they wanted to receive at the end of their life.

People said they were safe at the service. People were comfortable with staff and readily asked for their help and support. Staff had been trained to safeguard people from abuse. People and staff knew how and to who they should report any safety concerns. Changes had been made to recruitment practices to make sure people were supported by suitable staff. There were enough staff to support people. Health and safety checks were carried out of the premises and equipment to make sure they were safe. The premises was clean and tidy. Staff followed current practice to reduce infection and hygiene risks at the service.

People were supported to stay healthy and well. Staff were better informed about people’s healthcare conditions and the support they needed for these. The provider had improved access to support from healthcare professionals and people were able to see them when they needed to. Staff followed their recommendations to help people achieve effective outcomes. Information about people’s medicines had been improved and people received these as prescribed. People were involved in planning menus and had a choice about what they ate. Staff encouraged people to make healthy food and drink choices and monitored people were eating and drinking enough to meet their needs.

Staff training and supervision arrangements had been improved. Staff received relevant training to help them meet people’s needs. Staff were motivated and well supported. They understood their responsibilities for providing safe, high quality care and sought people’s consent before this was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People could choose how their bedrooms were decorated and personalised. Improvements had been made to the communal garden which had been cleared of clutter. People had more choice and say about the activities they did. Due to national lockdown restrictions at the time of this inspection there were limited opportunities for people to do activities in the community. However, people were supported to do more activities at home to keep them engaged and stimulated. People were supported to make video and telephone calls to relatives. Staff also provided relatives with updates about their family member.

The provider had improved their quality monitoring systems and made sure there were regular audits and checks of the service. They promptly addressed any issues identified through these checks. The provider had also improved their accident reporting and complaints systems to better understand and manage safety and quality concerns. Learning from incidents was shared with staff to help them improve the quality and safety of the support they provided.

The provider was open and honest with people about the things that had gone wrong and what they would do to put things right. The provider sought their feedback to check the action they took was leading to improvements for people at the service.

Despite the improvements made since our last inspection, it was too early to judge yet whether these could be maintained and sustained. Some of the planned improvements had not yet been fully embedded due to the current COVID19 pandemic. These issues were outside of the provider’s control. However, this meant at the time of this inspection there was not yet enough evidence of consistent good practice over time.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 24 March 2020) and there were multiple breaches of regulation. This service has been in special measures since 24 March 2020. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions we looked at. Therefore, this service is no longer in special measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 27 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care, dignity and respect, need for consent, safe care and treatment, receiving and acting on complaints and good governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of Safe, Effective, Responsive and Well-led which had been rated inadequate and contain those requirements.

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 coronavirus and other infection outbreaks effectively

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Restoration Residential Care Home provides care and accommodation to people with mental health needs. The service accommodates up to four people in one building. At the time of our inspection, three people were living there.

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

The provider had failed to ensure that people were supported in a safe way. Risk assessments did not identify and mitigate individual risk; medicines were not being managed safely; recruitment practices did not ensure staff were suitable to support vulnerable people and there was no recording or analysis of accidents and incidents. We also found that the systems in place to protect people from infection were not adequate. This placed people at risk of harm or unsafe care.

People’s needs were not adequately assessed. There were shortfalls regarding staff training and support through supervisions. The service did not support people to have a healthy, balanced diet and to stay well through engaging with other health and social care professionals. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems did not support this practice. The service was not always designed and adapted with people’s needs in mind.

People were not always treated in a kind manner. The service lacked a consistent approach to people and their relatives being involved in the care and support they received. The service was failing to ensure it promoted a culture of equality and diversity. People’s privacy and dignity was not promoted.

Care plans remained inconsistent and did not always guide staff to provide person-centred care. People were at risk of social isolation and did not engage in community activities. We found that the systems in place to manage complaints and end of life care were insufficient.

The quality assurance systems were inadequate as they had not identified the shortfalls we found during our

inspection and did not ensure people were always kept safe. We found the service failed to demonstrate they were providing care and support that was safe, caring, effective or responsive. This put people at continued risk of harm.

However, staff were up to date with safeguarding training and told us they felt supported. There were enough staff to meet people’s needs. Relatives told us they felt their loved ones were safe.

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

Rating at last inspection

The last rating for this service was good (published 1 June 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Enforcement

We have identified breaches in relation to person-centred care, consent, safe care and treatment, receiving and acting on complaints and good governance at this inspection. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Restoration Residential Care Home is a small care home which provides care and accommodation for up to four adults. The service specialises in supporting people with mental health needs. At the time of our inspection there were four people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider, who was also the registered manager, had taken the necessary action to make improvements needed to meet legal requirements. People’s care records now contained current information about their care and support needs so that people were protected against risks that could arise if this information was inaccurate or out of date. Records were stored securely but easily accessible when staff needed them. The provider had reviewed and updated the service’s policies and procedures and staff now had access to current information on how to undertake their roles appropriately to meet required standards.

We also found improvements had been made to the management of risks at the service. Risk assessments now detailed the measures put in place to minimise injury or harm that could be caused to people by an unsafe environment. The premises and equipment were regularly maintained and serviced to ensure these were safe and the environment was kept clean.

The provider had reviewed and updated management arrangements for medicines. The service’s medicines policy now reflected best practice. There was also now written guidance for staff on how and when to administer ‘as required’ medicines. People received their medicines as prescribed and these were stored safely.

The provider had improved the frequency of their audits and checks of the service to identify any shortfalls in the quality of the service so that prompt action could be taken to address this. They continued to ask for and act on people’s people views about the quality of the support they received and how this could be improved. Surveys were now also sent to healthcare professionals involved in people’s lives to seek their feedback about the quality of the service.

In order to sustain the improvements made, the provider had appointed a deputy manager to provide additional management support and oversight of the service. The deputy manager was well supported by the provider to make any changes that were needed when these were identified.

People were safe at the service. Staff knew how to protect people from the risk of abuse or harm. They took appropriate action to ensure identified risks to people's health, safety and welfare were minimised. The provider ensured there were enough staff to support people and keep them safe. They maintained appropriate arrangements to check the suitability and fitness of all staff to work at the service.

People continued to receive support which met their specific needs and had care goals and objectives which were focussed on them achieving and sustaining better physical and mental health. They were supported by staff to undertake tasks and activities to promote their independence at home and in the community. People’s care and support needs were reviewed regularly. The provider ensured staff received appropriate training and were well supported to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy, maintain their physical and mental health and to access healthcare services when needed. Staff encouraged people to maintain relationships with the people that mattered to them.

Staff were kind, treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were satisfied with the support they received from staff. People knew how to make a complaint to the provider if they were unhappy about any aspect of the support they received. The provider maintained arrangements they had in place to deal with people’s complaints appropriately. They had updated the complaints procedure so that there was now accurate information about what people could do if they wished to take a complaint further about the provider.

Restoration Residential Care Home is a small service which provides care and accommodation for up to four adults. The service specialises in supporting people with mental health needs. At the time of our inspection there were three people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider in breach of their legal requirement with regard to good governance. This was because not all records kept by the service had been maintained in such a way as to ensure these were accurate and up to date. You can see what action we told the provider to take with regard to this breach at the back of the full version of the report.

Assessments undertaken of the safety of the environment had not fully documented all the potential risks to people posed by the premises and equipment within it. Assessments of people’s individual rooms and communal areas in the home did not record some key risks that could be harmful to people. The registered manager confirmed measures were in place to manage these risks. However the lack of information in risk assessments meant there was no record for how the service ensured people were protected from the risk of injury or harm from these risks. Staff demonstrated a good understanding of how to keep people safe from risks posed by the environment. Where risks to people had been identified and documented, plans were in place to minimise these. Staff ensured the premises and equipment were clean, tidy, free from hazards and subject to maintenance and service checks.

Arrangements were in place to check the quality and safety of the service. The registered manager carried out a six monthly review of key aspects of the service. No issues had been identified at the last review in September 2015. However the registered manager acknowledged the frequency of checks needed to be reviewed in light of the issues about the quality of records. The registered manager had been proactive in making improvements when shortfalls in the service had been identified. Following visits made by the pharmacist and London Fire Brigade to the service, they took action to implement recommendations they had made.

People were asked for their views about how care and support could be improved, through surveys and residents meetings. However a survey was last done in April 2015 and minutes from recent resident meetings had not been recorded. This meant we could not gain a consistent view about the current effectiveness of the service in dealing with people’s suggestions for improvement.

The registered manager understood their role and responsibilities and encouraged an open culture within the service. People were satisfied with the care and support they received. People said they were comfortable talking to staff about any issues or concerns they had and they told us they felt listened to. The provider had arrangements in place to deal with any concerns or complaints people had in the first instance. However people were not correctly informed about how they could take their concerns or complaints further. The registered manager was taking action to rectify this.

People were supported by staff to take their prescribed medicines. Medicines were stored safely. Our checks of stocks and balances of medicines confirmed these had been given as indicated on people's records. We also identified there was no written guidance for staff on how and when to administer an ‘as required’ medicine. ‘As required’ medicines are medicines which are only needed in specific situations such as when people may require relief from increased anxiety. The registered manager acknowledged the lack of written guidance was not good practice and they would take steps to address this.

There were enough suitable staff to care for and support people. The registered manager had carried out appropriate checks to ensure they were suitable and fit to work at the home. Staff received relevant training to help them in their roles. They told us they were well supported by the registered manager and were provided opportunities to share their views and discuss any issues or concerns they had about work based practices.

People were involved in planning and making decisions about their care and support needs. Their support plans reflected their specific needs and preferences for how they were cared for and supported. Staff had a good understanding and awareness of people’s needs and how these should be met. People needs were regularly discussed and reviewed with them. People were supported to keep healthy and well. Staff ensured people were able to promptly access other healthcare services and professionals when needed. People were encouraged to drink and eat sufficient amounts to meet their needs.

People were encouraged to develop and maintain social relationships. Relatives and friends were welcome to visit with people at the service. People were also encouraged to build social networks in the community. People were supported to undertake activities of their choosing. They were also supported to develop and maintain skills designed to help them to live more independently.

Staff ensured people’s right to privacy and to be treated with dignity were respected. They spoke with people respectfully and supported them appropriately when they became anxious. Staff made sure confidential information about people was kept securely. The way they supported people during the inspection was respectful, caring and considerate.

People told us they were safe. They were given information about what to do if they were abused, harmed or discriminated against. Staff knew how to protect people if they suspected they were at risk of abuse or harm. They had received training in safeguarding adults at risk and knew how and when to report their concerns if they suspected someone was at risk of abuse. There was a procedure in place for all staff to follow to ensure concerns were reported to the appropriate person and authorities.

The provider had procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had received training to understand when an application under DoLS should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Following that inspection we asked the provider to take action to achieve compliance with the appropriate regulation. The provider sent us an action plan on 24 July 2014 setting out the steps they had taken to do this. During this visit we checked these actions had been completed.

This visit was carried out by a single inspector who helped answer one of our five questions:Is the service safe?

Below is a summary of what we found. The summary is based on what we saw from looking at records and from speaking with the provider. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found at this visit the provider had ensured appropriate pre-employment checks had been undertaken on staff employed by the service to ensure they were of good character, physically and mentally fit to perform the work and had the necessary qualifications, skills and experience to care for people using the service. We saw the provider had introduced monthly checks of records to ensure correct recruitment processes had been followed when people were employed to work at the service.

Below is a summary of what we found. The summary is based on our observations during the inspection and from looking at records. We also spoke with the person using the service, their care manager, the provider (who was also the registered manager), and the senior carer.

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

Is the service safe?

There was one person using the service at the time of our inspection who told us they felt safe living at the home.

The provider had assessed potential risks to their safety, health and welfare both within the home and in the community and made sure there was appropriate guidance for staff on how to manage these risks, to keep them safe from harm when providing care and support. Staff had also received appropriate information and training on how to protect people from the risk of abuse, harm or neglect.

However people were put at risk of unsafe or inappropriate care as the provider did not carry out all the checks they were supposed to, in respect of staff working at the home. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to recruitment.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted the provider understood when an application should be made, and how to submit one.

Is the service effective?

We saw staff had involved the person using the service in planning their care and support. Their views and experiences had been used to develop their plan of care. Their specific needs were taken into account. Staff we spoke with demonstrated a good understanding and awareness of their needs and in particular, what was important to them. Staff received regular training to support them in their roles, so people could be assured their needs were being met by appropriately skilled and trained staff.

Staff supported the person using the service to keep healthy and well by encouraging them to maintain a well-balanced and healthy diet and through regular exercise. Staff ensured they attended scheduled medical and healthcare appointments so that they got the medical care and attention they needed, promptly.

Is the service caring?

The person using the service told us staff were friendly and nice. They also told us staff encouraged them to maintain their independence by supporting them to do activities and tasks both in the home and out in the community.

Staff we spoke with knew how to maintain people's privacy and dignity, particularly when providing personal care. From our own observations we saw staff were kind and respectful and asked permission before carrying out any care and support.

Is the service responsive?

The person using the service was positive about the care and support they received from staff. We spoke with their care manager who told us they had noted a positive change in their overall health and wellbeing in the time they had been living at the home. They confirmed they had no concerns or issues about the care and support provided by the service.

Is the service well-led?

The provider had systems in place to monitor the quality of service provided. However it was too early to judge the effectiveness of these as the service has only been operational since April 2014. In the absence of formal quality assurance we found the provider had taken other steps to review and evaluate the care and support provided to ensure the needs of the person using the service were being met.

The person using the service told us their views about how their care and support was provided were listened to by the provider.