The Spinal Unit Action Group

The Spinal Unit Action Group, is located in a residential area of Southport. Accommodation is provided for up to 12 people who are physically disabled. The home is fully accessible for people who require wheelchair access. It is fitted with appropriate aids and adaptations to support people in their independence and to assist people to move and transfer safely around the home. The home is in close proximity to Birkdale village and public transport links to Southport and Liverpool are within easy reach. At the time of our inspection there were seven people living at the home.

The Spinal Unit Action Group is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

We last inspected the Spinal Unit Action Group on 28 February and 27 July 2017. We found two breaches of the Health and Social Care Act 2008 during this inspection in relation to safe care and treatment and good governance. We also made a recommendation in relation to the recording of complaints.

At this inspection there was a registered manager in post. 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.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, effective responsive and well led to at least good. During this inspection we saw that improvements had been made. The provider was no longer in breach of these regulations and had improved each key question to a rating of 'good'.

During our last inspection in February and July 2017 we found that risks to people's health and well-being were not always managed appropriately. This was because there was not enough detail in people's risk assessments which explained risk and how to keep the person safe. We found during this inspection that risk assessments had been re-formatted and now contained a high level of detail to help keep people safe from harm.

During our last inspection in February and July 2017 we found that audits and checks were not always consistently taking place to monitor the quality of the service. We found during this inspection the provider had taken appropriate action and a more robust checking and auditing system was in place.

People told us they felt safe living at the home and we received positive comments in relation to this. People also told us there was enough staff on duty at the home and there did appear to be enough staff.

Medication was safely managed, stored and administered. People received their medications on time.

Staff were recruited and selected to work at the home following a robust recruitment procedure. The registered manager retained comprehensive records of each staff member, and had undertaken checks on their character and suitability to work at the home.

The home was clean and tidy. There were provisions of personal protective equipment at the service, and staff were trained in infection control procedures.

Staff were able to describe the process they would follow to ensure that people were protected from harm and abuse. All staff had completed safeguarding training. There was information around the home which described what people should do if they felt they needed to report a concern.

The training matrix showed that staff were trained in all subjects which were mandatory to their role as stated in the provider's training policy. There was additional training in place which was overseen by medical professionals to ensure staff had the correct skills to support people with their clinical needs. New staff with no experience in health and social care were enrolled on an in-depth induction process. Staff received regular supervision and appraisal.

People were supported if they chose to attend healthcare appointments. Some people managed their own appointments themselves.

People were supported to eat and drink in accordance with their needs. Most of the people who lived at the home chose to go out at lunchtime, however there was a main meal provided and kitchens on each floor of the home so people could prepare meals and snacks

The service worked in conjunction with physiotherapists, health nurses to ensure people had effective care and treatment.

Everyone had records in their files relating to external appointments with healthcare professionals such as GP's, opticians, dentists or chiropodists. The outcome of these appointments was recorded in people's records.

Most areas of the home and some people's bedrooms had been refurbished.

The service was operating in accordance with the principles of the Mental Capacity Act (MCA). Everyone who lived at the home had capacity to make their own decisions.

We observed kind and caring interactions between staff and people who lived at the home.

There were positive examples of person centred information in peoples care plans. The new documentation was more in depth with regards to finding out more information about people, their likes, dislikes and how they wanted their support to be delivered.

There was a procedure in place to document and address complaints. Everyone we spoke with said they knew how to complain. The complaints procedure was displayed in the communal areas of the home.

Staff were aware of how to support people to manage their end of life wishes. Most of the people who came to the Spinal Unit Action Group came to aide their recovery and eventually moved back to their own homes once a period of rehabilitation had taken place.

Everyone knew who the registered manager was. The registered manager had been in post at the home for a long time alongside the deputy manager.

There was a registered manager in post. 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.

The Spinal Unit Action Group, known as 'Weld Road' is located in a residential area of Southport. Accommodation is provided for up to 12 people who are physically disabled. The home is fully accessible for people who require wheelchair access. It is fitted with appropriate aids and adaptations to support people in their independence and to assist people to move and transfer safely around the home. The home is in close proximity to Birkdale village and public transport links to Southport and Liverpool are within easy reach. A variety of amenities such as shops, pubs, a bank, and churches are also within a short distance of the home. At the time of our inspection there were seven people living at the home.

The home was last inspected in December 2015. During this inspection, we found two breaches of the Health and Social Care Act 2008 with regards to safe care and treatment and governance of the home.

During this inspection, we found that some improvements had been made in relation to the management of medication at the home. We saw, however, that despite some improvement being made with regard to risk assessments and governance, the provider had not improved enough to have met the breaches from the last inspection. We also found concerns during day one of our inspection relating to the fire safety of the building. We asked the registered manager to take action to address these concerns. When we returned for day two of our inspection the registered manager had taken appropriate action.

During our inspection in December 2015, we found that the provider was in breach of regulation 12 of the Health and Social Care Act relating to safe care and treatment. This was because some risk assessments did not always contain sufficient and up to date information to help keep people safe. Also, some medications were not always being managed appropriately. This was because there was not a procedure in place to record when people took medication as and when it was needed, referred to as PRN medication. In addition, most people required support from staff to apply different types of topical medication (creams) to their skin. There was no accompanying MAR or chart which directed staff where to apply the creams and when. This made it difficult to tell if people had actually had their creams applied or not. Following our last inspection the provider wrote to us advising what action they were going to take, we checked this as part of this inspection. We saw during this inspection that the registered manager had added new documentation with regards to PRN medications and creams, which was easier to follow. We did see however, that the controlled drugs book (CD) s often only had one signature recorded. Controlled drugs are medications with additional safeguarding’s placed on them under the misuse of drugs act. We discussed this at the time with the registered manager who assured us that all CD’s were to be signed by two staff in future. The provider was no longer in breach of this part of the regulation. We saw, however, during this inspection that despite some improvements being made, risk assessments relating to people’s care and safety were still not robust enough or in place to help support people. The provider was still in breach of this regulation.

During our last inspection in December 2015, we found the provider in breach of regulations relating to the governance of the home. This was because quality assurance audits and checks were not as robust as they should have been. Following our last inspection the provider wrote to us advising what action they were going to take, we checked this as part of this inspection. We saw during this inspection that some action had been taken and some audits had improved, however they were still not robust enough to identify some of the concerns we found during our inspection. The provider remains in breach of this regulation. We also identified that some records were not being kept or recorded for some aspects of service delivery. We also spoke to the registered manager and provider at length regarding some boundary concerns we identified during our inspection, as there appeared no clear guidelines for staff to follow.

During day one of our inspection, we raised some concerns regarding the layout of the home, particularly in relation to how people would evacuate safely in the event of a fire. Personal Emergency Evacuation Plans (PEEPS) in place for people were not specific enough to enable staff and emergency personnel to quickly identify how to support people to evacuate during an emergency. When we returned for day two of our inspection, we saw that the registered manager had contacted the fire department for advice and had updated the personal evacuation plans for everyone at the home.

Everyone we spoke with told us they felt safe at the home. We observed there was enough staff employed by the organisation to help keep people safe. Staff were aware of their responsibilities in relation to safeguarding, including how to raise concerns with their line manager as well as reporting to other organisations such as the Local Authority or CQC. Staff were recruited safely, most staff had been in post for a long time. One staff member had some information missing from their file, so we discussed this at the time of our inspection with the registered manager.

Staff training certificates showed that staff had been trained in all of the organisation’s mandatory training. This included additional training which was required to help staff support people with spinal injuries. We saw the certificates and course attendance lists for this training; however the training matrix which recorded all of the training staff had completed required updating.

We saw that supervisions were not always taking place at structured times throughout the year. Some staff had received supervision; others had not received any formal documented supervision. We saw that everyone had received an annual appraisal.

People were supported in line with the principles of the Mental Capacity Act 2005, and we saw this guidance was taken into consideration when care plans were developed. There was no Deprivation of Liberty Safeguards (DoLS) in place at the time of our inspection.

People choose what they ate. There was an evening meal prepared for people if they chose to have it, however other foods were prepared as and when people wanted them. People living at the home had the option of eating either in their own bedrooms or in the communal dining room. There were adapted kitchens on each floor of the home for people to use when they wanted.

People were supported if they chose to attend healthcare appointments. Some people managed their own appointments themselves. If people consented, we saw a log was kept of their appointments, other people did not have this record because they chose to keep their appointments private.

Everyone told us they felt the staff were caring, and we observed kind and caring interactions over both days of our inspection.

Care plans we viewed were mixed in their presentation, some care plans contained examples of good person centred approaches to people’s care and fully evidenced people had a choice in how they wished to be care for. Other people’s care plans were vague and records showed that they had not been reviewed as often as they should have been. We saw during day two of our inspection that the registered manager was actively reviewing and rewriting care plans to include more personalised information about people’s individual likes and preference’s.

There was a complaints process in the place; however the complaints policy did not contain sufficient information to support people if they wished to make a complaint. Everyone said they knew how to complain. We saw there had been one complaint, which had been investigated by the registered manager. We have made a recommendation about complaints.

Everyone spoke positively about the registered manager and the provider. The registered manager was clearly ‘hands on’ within the home and everyone knew them well.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager. There were no concerns with regards to people's capacity to make their own decisions and people were encouraged to be independent and use the local community.

People's health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people's safety were well managed.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare.

People who lived at the home felt very much listened to and included in day to day decision making. They also felt included in making decisions about how the service was run.

Is the service caring?

People who lived at the home told us staff were caring and respectful. Staff told us they were clear about their roles and responsibilities to promote people's independence and respect their privacy and dignity.

People were supported by attentive staff who were readily available to support them. We saw that staff showed warmth and familiarity when supporting people. People commented, 'The care we get is first rate, they would do anything for us' and 'The atmosphere is relaxed and friendly we have a great laugh together, we are just like a family.'

Is the service responsive?

The service worked well with other agencies and services to make sure people received their care in a joined up way. GPs, district nurses and other health professionals were referred to promptly when people required support with their health care needs.

People who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. This was done through the use of surveys and regular resident's meetings. People's feedback was then used to make improvements to the service.

Is the service well-led?

Systems were in place for assessing and monitoring the quality of the service. These included regular checks on practice and seeking the views of people who lived at the home.

The service was managed in a way that ensured people's health, safety and welfare were protected and the interests of the people who lived at the home was at the centre of how the service was run and managed.

Staff felt well supported and appropriately skilled and experienced to carry out their role. However, some of the systems required to support staff in their work were not in place. We have asked the provider to tell us what they are going to do to meet the requirements of the law to ensure the appropriate planning of care and support for people who live at the home.

We looked at three care plans, all of which had a range of risk assessments, for example, falls, mobility and continence. We saw all care plans were person centred and took peoples hobbies and interests in to account. We saw people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

All five service users we spoke to said the home environment was very 'homely' and they said the staff were all 'very kind'. All five felt they were very well cared for. One service user we spoke to told us that staff were very knowledgeable about their conditions especially spinal injuries. We spoke to one physiotherapist who also corroborated this. The physiotherapist also said they felt the service users were very well cared for.

The way in which staff were recruited was found to be correct and safe. Staff showed evidence of previous experience and continuing professional development within healthcare.

We saw the home had developed their own medication sheets where the administration of medicines records were handwritten. Due to the evidence gathered it was established that the way in which medicines were recorded and stored were not safe.

People we spoke with told us they were fully involved in deciding what care and support they required and how and when this would be provided. One person commented, 'No-one forces anything on you. They are always about to help but they don't tell you what to do. They don't assume anything.'

Training records confirmed that staff had safeguarding training as part of their mandatory training and refresher training was also part of the ongoing training plan.

We saw written procedures for the safe ordering, receipt, storage and administration of medication. We found that medication was stored securely and the home had systems in place to monitor how medication was managed and identify any actions required.

We looked at the staffing levels within the home and found that they were based on the needs of the people living there. People we spoke with told us that there were always staff about when they needed them.

The service had accurate and up to date records related to the running of the home which assisted in maintaining a safe environment for people and staff to live and work in.