Calder View

Calder View is a residential care home providing personal care to up to 6 people. The service accommodates people who require support with their mental health. At the time of our inspection there were 6 people using the service, who resided in one building which had 2 floors.

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

Staffing levels were lower than required on some shifts. The service was in the process of recruiting a new staff member to address this. Recruitment processes needed improving to ensure full employment history was being sought. We made a recommendation about this. Medication pill counts matched records, but some paperwork relating to medicines needed to be put in place, guidelines needed to be followed and medicines audits needed to be more robust. We made a recommendation about this. Although the home was clean and tidy and people were supported to have visitors, on arrival staff were not appropriately wearing face masks, as the provider’s policy did not align with national guidance. This was immediately rectified. We made a recommendation about this. Systems and processes were in place to safeguard people from abuse, however we found one example where necessary referrals had not been made. We were able to review some examples of lessons learned and there were appropriate risk assessments in place.

Quality assurance systems required some improvement, the medicines audits did not identify all of the concerns we found and the provider had not completed the provider information return (PIR) when requested. The registered manager spoke about being open and honest when things went wrong, however we did find one incident that had not been appropriately reported, this was before the registered manager’s time in post. We received positive feedback about the registered manager and staff knew how to escalate concerns if necessary. Staff worked in partnership with various agencies and the service engaged with people and their relatives to help drive improvement.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 18 July 2018).

Why we inspected

We made a decision to inspect Calder View after completing a full review of information we hold 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 effectively.

We undertook a focused inspection to review the key questions of safe and well-led only. 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 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 Calder View on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to governance at this inspection. We have also made recommendations in relation to medicines, recruitment practices and infection control practices.

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.

Calder View is a ‘care home’ which is registered to provide care and accommodation for up to six adults with mental ill health. People in care homes receive accommodation and nursing 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. Nursing care is not provided at Calder View. At the time of our inspection five people were using the service.

The service was managed by a registered manager. 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. In the absence of the registered manager the provider had made interim arrangements for the management of the service.

At our last inspection in March 2017 the service was rated Requires Improvement. This was because the provider had failed to ensure there were safe staff recruitment processes. This was a reoccurring breach of the regulations. We therefore issued the provider with a Warning Notice to make improvements. Recommendations were also made on improving medicine management processes and promoting healthy eating. At this inspection we found action had been completed to make improvements.

During this inspection we found there were no breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. At this inspection we found the evidence to support the rating of Good.

We found there were management and leadership arrangements in place to support the effective day to day running of the service. The registered manager had made a number of improvements and the provider was monitoring the service.

Staff recruitment procedures had improved. Robust processes were in place to make sure all appropriate checks were carried out before staff started working at the service.

There were enough staff available to provide care and support; we found staffing arrangements were kept under review.

People told us they felt safe at the service. Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff had received training on supporting people safely and abuse and protection matters.

Systems were in place to maintain a safe environment for people who used the service and others.

We noted some of the windows were in need of attention, however we found the provider had taken action to make improvements.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities and preferences before they used the service. They were encouraged to visit, to experience the service and meet with other people and staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and processes at the service supported this practice.

We found people were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to. People had been supported to increase their awareness of their wellbeing and health care needs.

People were satisfied with the meals provided at Calder View. People were actively involved with devising menus, which meant they could make choices on the meals provided. They had been given information on healthy eating and balanced diets.

People made positive comments about the care and support they received from staff. We observed positive and respectful interactions between people who used the service and staff.

Each person had a care plan, describing their individual needs and choices. This provided guidance for staff on how to provide support. People had been involved with planning and reviewing their care.

People’s privacy, individuality and dignity was respected. They were supported with their hobbies and interests, including activities in the local community and keeping in touch with their relatives and friends. People had opportunities for skill development and confidence building.

There were processes in place for dealing with complaints. There was a formal procedure to manage, investigate and respond to people’s complaints and concerns. People could also express concerns or dissatisfaction during their care reviews and during residents meetings.

There were systems in place to consult with people who used the service and staff, to assess and monitor the quality of their experiences. Various checks on quality and safety were completed regularly.

Calder View is a mid-terraced, garden fronted house located near the centre of Colne. Shops and services are a short distance away and transport links are nearby. There are six single bedrooms and two communal lounges. There is an enclosed garden area to the rear of the home and roadside parking to the front of the home. The service provides accommodation and personal care for up to 6 people with mental ill health. At the time of the inspection there were 6 people accommodated at the service.

The service was managed by a registered manager. However the registered manager was not on duty at the time of the inspection. 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.

At the previous inspection we asked the provider to make improvements in relation to a lack of robust recruitment procedures prior to staff working at the service. We received an action plan from the provider indicating how and when they would meet the relevant legal requirements. At this inspection we found the required improvements had been made. However we identified further shortfalls in recruitment practices which meant there was a continued breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have also made recommendations on improving medicine management processes and promoting healthy eating.

The people we spoke with indicated satisfaction with the care and support they experienced at Calder View. Although people had some concerns about the behaviour of others, they did not express any concerns about the way they were treated or supported. They had access to information on abuse, protection and safeguarding. Individual risk assessments had been carried out and staff were given instructions about how to manage any risks to help keep people safe.

Staff expressed a good understanding of safeguarding and protection matters; they knew what to do if they had any concerns. There were enough staff available to provide care and support and we were told staffing arrangements were kept under review.

Systems were in place to maintain a safe environment for people who used the service and others. We found there was a safety matter needing attention; action was taken to put this right during the inspection.

The service was working within the principles of the MCA (Mental Capacity Act 2005). We found people were supported to make their own decisions and choices. They were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were satisfied with the meals provided at Calder View. People were actively involved with devising menus, which meant they could make choices on the meals provided. Some people were supported to cook their own meals as part of their skill development.

People made positive comments about the care and support they received from staff. We observed positive, sensitive and respectful interactions between people using the service and staff.

There was a focus upon promoting and maintaining independence skills. Each person had a care plan, describing their individual needs and choices. This provided clear guidance for staff on how to provide support. People’s privacy, individuality and dignity was respected.

People were supported to pursue their interests and lifestyle choices, including activities in the local community. They were supported to keep in touch with their relatives and friends. People’s well-being was monitored and reviews of their needs were regularly held.

There were processes in place for dealing with complaints. There was a formal procedure to manage, investigate and respond to people’s complaints and concerns. People could also express concerns or dissatisfaction during their care reviews and in residents meetings.

There were systems in place to ensure staff received regular training, development and supervision. The service had a management and leadership team to direct and support the day to day running of the service. There were systems in place to consult with people who used the service and staff, to assess and monitor the quality of their experiences.

People were being involved as far as possible in making decisions about matters which affected them. They were supported to make choices and develop independent living skills. People were supported to access resources and activities within the community.

People were getting support with healthcare needs and they had access to on-going support from health care professionals.

People were provided with safe, comfortable and pleasant accommodation.

We found the staff training and development was sufficient in helping to ensure people received effective care and support.

There were systems in place to help support people to make complaints and raise concerns. But, procedures needed updating to make sure people had all the correct information.