Archived: The Ormerod Home Trust Limited - 2 Headroomgate Road

Updated 13 February 2019

We carried out this comprehensive inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection visit took place on 7 and 14 December 2018 and feedback on 20 December 2018. Day one was unannounced and day two and feedback were announced.

The inspection team consisted of an adult social care inspection manager and five adult social care inspectors on day one and an adult social care inspection manager and adult social care inspector on day two.

We carried out this comprehensive inspection because of a significant number of concerns and safeguarding matters about the care and management of the service. We assessed if there were ongoing regulatory risks to people who used the service. Before our inspection we reviewed the information we held on the service. This included notifications we had received from the provider, about incidents that affected the health, safety and welfare of people the service supported. Also, information concerning the care and welfare of people who used the service.

We contacted the commissioning department at Blackpool council, Lancashire County Council and Healthwatch Lancashire. Healthwatch Lancashire is an independent consumer champions for health and social care. This helped us to gain a balanced overview of what people experienced accessing the service.

As part of the inspection we used information the provider sent us in their last Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with a range of people about the service. They included seventeen people who lived in supported houses or received domiciliary care visits and four relatives of people who received care and support. We also spoke with the Chief executive and three members of the management team and fourteen care staff. We visited five supported houses, talked with people attending the day services who lived in supported houses and people who received domiciliary visits. We visited the office location, looked at seven care records and risk assessments and the medicines information of twelve people, staff recruitment and supervision records of three staff. Staff training matrix and staff and service user rotas. We looked at records relating to the management of the service and quality assurance monitoring.

Updated 13 February 2019

This inspection visit took place on 7 and 14 December 2018. Day one was unannounced, day two was announced. Feedback was provided to the management team on 20 December 2018.

The Ormerod Home Trust Limited - 2 Headroomgate Road provides support to adults with a learning disability across the Fylde, Blackpool, and Wyre areas of Lancashire. People's support is based on their individual needs and can range from 24-hour care within a supported living environment to a set number of visits each week from the domiciliary service. The service provides personal care to people living alone or with family or friends in their own houses. It provides personal care and support to people so they can be as independent as possible. The supported living scheme enables people with a learning disability to live in supported accommodation. People have their own tenancies, with the properties being owned by different housing associations. The landlords are responsible for the maintenance and up keep of the individual properties.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. For example, we saw the location of people's homes enabled people to have easy access to health and social care services and the option to be a part of their local community.

People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living or domiciliary care; this inspection looked at people's personal care and support.

At the time of our inspection visit, The Ormerod Home Trust Limited - 2 Headroomgate Road supported 70 adults with a learning disability in supported housing and 45 adults who received domiciliary care.

There was a registered manager in place. A registered manager is a person who has registered with CQC 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. Having a registered manager is a condition of registration with CQC. The registered manager was not present during the inspection. An additional registered manager who was present for part of the inspection became registered with CQC during the inspection visits.

We carried out this comprehensive inspection because of a significant number of concerns and safeguarding matters about the care and management of the service. We assessed if there were ongoing regulatory risks to people who used the service. The service was working openly and transparently with the authorities whilst investigations were undertaken.

At our last inspection in December 2017 we rated the service good. At this inspection we found the service had changed to a rating of requires improvement.

Procedures were in place and staff told us they knew what to do if they saw poor practice or potential abuse. However, safeguarding/disciplinary practices did not always protect people from harm. Safeguarding alerts had been raised and investigated but the service had not always taken appropriate action. This increased risks to people supported.

This was a breach of Regulation 13.2 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure safeguarding processes were operated effectively to prevent the risk of abuse of service users.

Governance was not always effective. Although quality monitoring was carried out, the senior Management Team did not always receive sufficient or timely overviews of accident/incidents, complaints, audits or actions taken. This reduced their knowledge and the effectiveness of the service.

This was a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure systems or processes were operated effectively to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk.

A number of concerns had been raised with the senior management about communication and care. We were shown evidence of action taken, and in progress by the senior management to address concerns that had been brought to their attention. People were complimentary in the main about communication from staff. However, one relative told us communication was starting to improve although they did not always get consistent responses from the office.

Recruitment and selection checks had been carried out before new staff could start working for the service so the risk of unsuitable staff was minimised. However, we recommended that the service develop risk assessments to reflect staff medical conditions to improve safe working.

Although there had been a turnover of staff people told us they were usually supported by the same group of staff who they knew. They told us they were familiar with their needs and preferences. We had received comments regarding problems with staffing. We did not see this on inspection but recommended frequent reviews of staffing to ensure sufficient levels of skilled and experienced staff were employed.

Staff had received training in most areas about how to care for people which assisted them in carrying out their roles. However not all staff working with people whose behaviour could challenge, had completed positive behaviour training and one person did not have guidance for supporting them when they had behaviour that challenged.

Risk assessments were in place for almost all care records checked. This provided guidance for staff and assisted in supporting people safely. Staff supported people with and managed medicines in accordance with medicines guidance. People we spoke with told us staff supported them with medicines as prescribed. We saw all except one supported house carried out weekly monitoring audits of medicines. Staff in one house had not completed these for several weeks which meant errors or omissions in that house may have gone unnoticed.

People supported and their relatives told us staff supported them or their family member in a friendly and caring way. One person said, “All my staff are very polite and friendly.” A relative told us, “We have some fantastic carers. They are very diligent and know [family member] well.”

Staff supported people to get involved in shopping and preparation of a nutritious dietary and fluid intake and staff had completed food safety training. There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of infection.

Care plans were in place detailing how people wished to be supported. People who received support where possible or their relatives had been involved in making decisions about their care.

Staff understood the requirements of the Mental Capacity Act (2005). People who received support consented to care where they were able. Where people lacked capacity, appropriate best interests’ decisions were carried out.

People we spoke with knew how to raise a concern or to make a complaint. The complaints procedure was available to them and they told us any concerns were listened to and acted upon. People supported and their relatives said they were encouraged to give their opinions about the quality of care. They told us they were satisfied with the support they received.