Archived: Care Management Group - 361 The Ridge

Care Management Group – 361 The Ridge is a residential care home providing personal care to 11 people living with a learning disability at the time of the inspection.

The service was a large home, bigger than most domestic style properties. The service can support up to 12 people in one adapted building. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs outside to indicate it was a care home. Staff did not wear uniforms and therefore were not immediately identifiable as care staff when coming and going with people.

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

Quality assurance checks and the governance of the service was not always robust. There had been a delayed response to a person’s changing needs. This had led to delays in the person receiving the right healthcare support. People and their relatives’ feedback about the service had not always been acted on or responded to. There was a lack of management oversight of incidents and accidents that meant there was an increased risk of reoccurrence. Notifications had not always been submitted to CQC.

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. However, when people had authorised Deprivation of Liberty Safeguards (DoLS) this was not always known by staff. The manager recognised this as an area in need of improvement.

People told us they felt safe. Staff understood safeguarding, types of abuse and how to report any concerns they had about people’s safety and well-being. People received their medicines safely and were protected by the prevention and control of infection.

People and staff had positive relationships. Staff interactions with people were kind and caring and showed they knew people well. People were treated with dignity and respect, their independence respected and promoted.

There were enough staff available to support people. There were staff vacancies at the time of the inspection and the manager was continuing to recruit new staff. Staff new to the service were supported with induction and then ongoing training and supervision. The staff team met regularly together to discuss the service.

People needs and wishes were assessed before they moved into the service. Care plans included various aspects of people’s lives including life histories, their likes and dislikes and health conditions. When people had specific health conditions these were well planned for. People were supported to access healthcare professionals.

The service applied the principles and values of Registering the Right Support. This is to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them maintaining their current independence and having opportunities to gain new skills and become more independent.

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 11 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to good governance at 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 for the provider to understand what they will do to improve the standards of quality. We will work alongside the provider and 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.

This inspection took place on 26 and 28 October 2016 and was unannounced. The previous inspection took place on in August 2014. The service met all the regulations we looked at.

The service had a registered manager at the time of our inspection but had resigned and was due to leave the service on 28 October 2016. 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 provider had put plans in place for a senior manager and two experienced registered managers from services of the same provider in the local area to oversee the operations at the service, until such a time a registered manager was appointed. The service was being managed this way at the time of this inspection. We are keeping the situation under review to ensure the service has a registered manager as soon as possible.

People told us they felt safe at the service. Staff knew how to protect people from the risk of abuse. The service carried out risk assessments, audits and checks regarding the safety of people and security of the premises regularly. Staff had risk management plans about how to support people to be as much independent as possible while keeping them safe. The provider recruited staff safely and ensured there were sufficient numbers of staff to meet people's needs.

People received their medicines safely. Staff used effectively medicines management systems in place to account for all the medicines each person had been given and how much was left in stock.

People had access to health care professionals when necessary. Staff responded to any changes in people’s health as appropriate and in a timely manner.

People and their relatives told us staff were kind and caring and knew people well. Staff treated people with respect and maintained their dignity and confidentiality.

Staff had developed positive relationships with people and their relatives. People were supported to participate in social activities including community based outings. People had sufficient food and drink and received appropriate support with their dietary needs.

Staff understood and followed the principles of the Mental Capacity Act 2005 when supporting people. Staff knew their role in relation to the Deprivation of Liberty Safeguards and how to support people without depriving them of their liberty unlawfully.

Staff asked people’s consent about care and treatment and supported them to make decisions were appropriate. People told us staff listened to them and respected their choices and decisions.

People, their relatives and staff were positive about the management of the service. The service asked people about the quality of their care and felt the registered manager acted on their views.

Staff received the support and training required to undertake their role. Staff had the knowledge and skills necessary to support people appropriately.

Staff assessed people’s needs and care plans had sufficient information on how people wanted to be supported. People and their relatives were involved in the planning and reviewing of people’s care. People received care that met their individual needs and preferences.

People, their relatives and staff knew the management team and found them to be approachable and easily available. The provider and manager checked the quality and safety of the service people received and made changes when necessary.

Our inspection team was made up of one inspector. This was a responsive inspection to look at the improvements made following our previous inspection in May 2014 where we found that people were not always cared for in a clean and hygienic environment. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

We found that action had been taken to improve the standard of hygiene and infection control in the service. Communal areas, toilets and bathrooms were visibly clean and free from unpleasant odours. There were clear systems in place to make sure that the standard of cleanliness was maintained. Staff had the equipment they needed to keep the risks of cross infection to a minimum.

Our inspection team was made up of two inspectors. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that some areas of the home, such as a shower area were not maintained to an appropriate standard which meant there was an infection control risk. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

There were a sufficient number of staff on duty to ensure that people received appropriate care and treatment. The staff we spoke with said that they felt there were enough staff on duty to carry out their roles.

We found that there were suitable records relating to people who used the service which were up to date and clearly written. Records were available to the staff that needed to see them and were stored appropriately.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received the training they needed to meet the needs of the people receiving care. Staff had opportunities to discuss any issues with colleagues or in private with a manager. One staff member said "There is good staff support" and another commented "I get regular supervision and appraisals".

Is the service caring?

People were supported by committed and caring staff. We observed that people appeared comfortable in the home and familiar with the staff that worked there. We saw that staff members spoke directly with people and supported them at an appropriate pace. There were regular resident meetings which supported people to get involved in the service. One person told us "I love it, I'm with my friends' and 'Staff are nice".

Is the service responsive?

People's needs were continually assessed. Records confirmed people's preferences, interests, goals and diverse needs had been recorded and support had been provided in accordance with people's wishes. People had regular review meetings with keyworkers to make sure that changes in needs were identified and action taken.

Is the service well-led?

Staff had a good understanding of their roles in the service and said that they were supported by management. There were quality assurance processes in place to maintain standards in the service. We saw that staff and people who used the service were given opportunities to express their views.

We found that staff demonstrated knowledge of the people living in the home and observed kind interaction between staff and the people they were supporting. One person liked helping at meal times. Another indicated that they enjoyed drawing. However, for two people we saw very little interaction during the day. We found that activity plans were out of date and did not reflect each person’s current needs and abilities.

Staff demonstrated knowledge of safeguarding processes and we found work underway to review policies and improve staff training.

Staffing levels were lower than considered optimum for the dependence and number of people in the home.

The home was not completing the regular internal audits required by the provider. The provider audits were not monitored and followed up to ensure that the quality of the service was maintained. We found that record keeping was not up to date in many areas.

We found that people were involved in decisions about their life as far as was possible. We also saw that people were involved in the decisions about how the home was run and the décor of their rooms. Care plans and risk assessments were in place and reflected people's needs and aspirations. The home was clean and comfortable and the food provided was varied and nutritious.

We saw that quality assurance systems were in place and were audited regularly to ensure that the service was run in the best interests of the people who used the service.