Anchor Integrated Care & Housing Village - Denham Garden Village

We previously inspected the service on the 1 and 2 December 2016. The service was rated Requires Improvement at the time. That was the second time the service had been rated Requires Improvement. We made five recommendations across the domains of Safe, Effective and Well-Led. At this inspection we found improvements had been made in all areas identified.

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. At the time of the inspection 25 people were being supported with personal care.

The service had 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.

We received positive feedback from people, their relatives and staff on how the service was led. Comments included “The care assistants are of the highest quality. I cannot fault them, I am given excellent care,” “I cannot speak highly enough of them [Care workers], professional, wonderful and friendly and “They [care workers] are absolutely wonderful, incredibly kind, compassionate and caring.”

Staff were aware of how to safeguard people from abuse and knew what action to take if a concern was raised.

The provider had processes in place to ensure the staff had the required skills and experience to work with people. All the required pre-employment checks were routinely carried out.

Staff were supported to develop their skills and knowledge through training. Staff felt supported in their role and received regular communication and one to one meetings with their line manager.

Staff were aware of the need to report any incidents and accidents.

People were supported by staff that had developed a good working relationship with them. Staff were aware of people’s likes and dislikes.

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. Staff

Systems were in place to monitor the quality of the service. The provider shared learning and knowledge across the organisation to ensure people received safe, compassionate and kind service.

At the time of the inspection, 24 people used the service and there were 10 staff. People received calls in their homes at set times throughout the day. At the time of the inspection, the service did not operate 24 hours a day. However people, relatives or healthcare professionals could contact the village concierge anytime to receive support. The service had plans in place to change the service to be operating all hours of the day and night.

People were protected against abuse or neglect. We heard various comments such as, “Quite safe, I would speak to the manager if I did not feel safe with staff” and “Absolutely, I can stand up for myself and will report it to the manager. I have not any experience of that (abuse),”

There were sufficient staff to meet people’s needs and the service appropriately determined correct staff deployment. Feedback from people and relatives indicated that staff were rarely late to calls but people told us they were not concerned. When we checked care records, delays in calls were minimal or did not exist. We have made a recommendation that the service seek current guidance on implementing methods for monitoring late or missed calls.

Recruitment and selection of new staff members was not always robust and therefore did not ensure safety for people who used the service. Some documents and checks required by the applicable regulation were unable to be evidenced at the inspection. We have made a recommendation that the service follow best practice in relation to recruitment in the sector.

People’s medicines were administered, stored and disposed of appropriately. However staff did not have completed competency assessments to document their safe ability to manage people’s medicines. The service also needed to ensure that they followed the provider’s medicines procedures, and used the appropriate documents. We have made a recommendation that the service ensures it’s local medicine policy is updated and followed to reflect best practise and be fit for purpose.

We found staff received improved induction, training and supervision. The service utilised Skills for Care’s ‘Care Certificate’ for new care workers and there was evidence that this was completed. More effort was required with the commencement and completion of staff performance appraisals. We made a recommendation that the service implements a better method of collating information about staff development.

We found consent was gained before care was commenced and people’s right to refuse care was respected by care workers. The homecare coordinator checked that people’s lasting power of attorney details documented and a copy was on file.

People were positive about the caring nature of staff. Comments included, “Apart from looking after the way they (Staff) should, they (Staff) show concern and interest in me. We have a laugh and a chat. Carers are just nice” and “Carers are like a family and individually caring.” People received care and support from staff who had got to know them well and told us their privacy and dignity was respected. We found people were supported to exercise choice and where possible encouraged to be independent.

People said the service was responsive as the care delivered centred was centred on their needs and wishes. They said if they had any concerns about the service they would report it to the manager and confirmed they were given information on how to make a complaint. There were a wide variety of scheduled activities designed to meet people's social needs and prevent social isolation.

We found significant improvements had been made since our last visit but further improvements were required. We have recommended the service seek advice and guidance in relation on how to audit recruitment records; monitor and analyse calls and keep staff updated with relevant with policies and procedures.

People were very complementary about the changes the new manager had made since joining the service. They told us there was a “marked difference” since their arrival. The service made improvements and changes to work practices as a result of feedback received from people and staff.

People's care plans contained a good level of information that ensured their needs were being met. We spoke with four people and they told us they were happy with the care, treatment and support they received. People described the care as "Very good", " absolutely brilliant" and "Just fantastic... I could not fault the staff." We also spoke to relatives of the people who used the service and one relative told us "They know (X) very well and understands his needs and requirements."

People supported by the agency and their relatives told us they felt very safe with the staff from the agency and they hadn't had to raise any concerns. Records were kept of complaints received at the service and how they had been responded to. People we spoke with did not have any complaints about their care.