Archived: Warrington Community Living - 53 Twiss Green Lane Residential Care Home

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Since the previous inspection a new registered manager has been in post who has worked hard with staff to make improvements to the service. The management team and staff promoted a culture that was person-centred and inclusive. Staff were motivated to deliver care and support that was based on people’s needs and choices. People were treated with kindness, compassion and respect and staff interacted well with people. Staff knew people well and how best to support them in the least restrictive way possible.

The atmosphere within the home was calm, friendly and joyful; people felt relaxed during the inspection process and happily invited us into their home. People were keen to tell us how happy they were and how much they enjoyed living in the home. People were proud to tell us and show us the things they had done since living in the home and spoke positively about the caring approach of the staff team. Strong familiar relationships had been built between staff and people and it was clear that a genuine mutual friendship had been developed.

People told us they felt safe living in the home and family members were confident their loved ones were safe and well looked after. Risks people faced were assessed and those identified were safely managed. Medicines were managed safely by trained staff; appropriate assessments were in place for those who managed their own medicines. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. The environment was safe and people had access to appropriate equipment where needed.

Enough suitably qualified and skilled staff were deployed to meet people’s needs. Since the previous inspection the registered manager had worked hard to recruit new staff and ensure required training was up-to-date. Staff told us they received a good level of support from the management team and felt able to approach them at any time.

People’s needs and choices had been assessed and planned for and care plans identified intended outcomes for people and how they were to be met in a way they preferred. Family members told us they felt their loved ones received the right care and support from well-trained staff. People were encouraged and supported to eat and drink well and were supported to access healthcare when needed. Staff worked hard to advocate for people to ensure they received the health care they were entitled to. Staff continuously offered people choice and control and where able to, consented to their care and treatment. Where people lacked capacity to make their own decisions they were made in their best interests in line with the Mental Capacity Act.

People, staff and family members all described the management team as approachable and supportive. The passion, knowledge and experience held by the management team created a relaxed environment for everyone; it was clear that people were put first and staff worked around what they wanted and how they wanted to spend their day. The management team showed a desire to improve on the service and were always looking at ways to do this. Effective systems were in place to check the quality and safety of the service.

Rating at last inspection: Requires Improvement (report published March 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The home is registered to accommodate up to four adults with learning disabilities, physical disabilities or mental health needs. The home is a four bedroom bungalow in a residential area of Warrington.

At the last inspection the service was rated good. At this inspection we found that some improvements to the service were needed and this rating had not been maintained. This was because at this inspection we found breaches of regulation 12 (safe care and treatment), regulation 18 (staff support and training) and regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. This meant that the domains of safe, effective and well-led were rated requires improvement.

During our inspection we reviewed how people’s needs and risks were assessed and managed. We found that although some of the risks associated with people’s care were assessed and staff provided with sufficient guidance on how to manage these risks, others risks were not. This meant there was a risk that inappropriate and unsafe care would be provided.

The provider’s risk assessment relating to the identification and management of Legionella bacteria in the home’s water supply was overdue and the actions identified as necessary to mitigate risks had not been undertaken. This placed people at risk of contracting a Legionella type infection. Legionella bacteria naturally occur in soil or water environments and can cause a pneumonia type infection. It can only survive at certain temperatures. Under the Health and Safety Act 1974, a provider has a legal responsibility to ensure that the risk of legionella is assessed and managed.

Some aspects of the way medication was managed at the home required improvement. One person’s medication was not stored securely and their ability administer to their own medication had not been assessed. Stock levels were correct for all but one of the medications and staff had received training in how to administer people’s medicines. The competency of staff to administer medication however had not been assessed since 2016. This meant there was no robust evidence that staff continued to be competent in the administration of medication

Staff training was not up to date for some staff members and the majority of staff members had not had a supervision meeting with their line manager for 12 months. There was also no evidence that staff members had received an annual appraisal of their skills and abilities since the last inspection. This meant that staff had not received appropriate managerial support to do their job role effectively.

The provider’s complaints procedure required improvement as it was not in a format that met the legal requirements of the Accessible Information Standard that came into force in 2016. The provider’s complaints procedure was not in easy read format. It was written in small print and there were no pictures, photographs or symbols used in the procedure to make it easy for the people who lived at the home to understand.

The governance systems in place to monitor and manage the quality and safety of the service had not been maintained during a period in which there was no registered manager in the service. We were told the registered manager of the service left in approximately May to June 2017 and from the records we looked at, the quality assurance checks in place had not been continued from this time. This meant the risks to people’s health, safety and welfare had not been properly managed. At the time of this visit, an acting manager had just recently been appointed and was in the process of becoming registered with CQC.

There were limited mechanisms in place for people to share their views of the service and the support they received. There were no residents’ or relatives’ meetings and people’s satisfaction with the service had not been properly assessed to enable the provider to gain an informed view of the quality of the service received.

People we spoke with told us they were happy with the support provided. They told us staff were kind and caring and that they could choose how they lived their life at the home. It was clear during our visit that staff and the people who lived at the home were comfortable with each other and the atmosphere was homely and jovial.

We observed that staff interactions with people who lived at the home were person centred and it was clear that staff knew people well. Care plans contained good information about the person, their likes and dislikes, social interests and hobbies and how they preferred their support to be provided. We saw that people were supported to pursue the hobbies and interests that they were enjoyed and it was clear that people’s independence was promoted where possible.

People’s health needs were well monitored and people had access to specialist and routine health and social care professionals in support of their health and well-being. We saw that some people had specific health conditions that required proactive management and records showed staff were responsive to people’s healthcare needs.

One of the people who lived at the home required help with making decisions in accordance with the Mental Capacity Act. We found that both the acting manager and team manager had a good knowledge of this and how to ensure any decisions made were in the person’s best interests.

People told us that they got enough to eat and drink and were involved in choosing what meals they had each week. People’s nutritional needs were assessed and monitored and where people had special dietary requirements staff had clear information on how to support these needs.

Staff recruitment was safe and the number of staff on duty was sufficient to meet people’s needs.

No accident or incidents had occurred at the service since the last inspection. Staff we spoke with understood how to protect people from the risk of abuse but staff training in this area had not been renewed appropriately.

' Is the service safe?

We found that the provider (Warrington Community living) had taken appropriate action to improve records. This helped to ensure people were adequately protected from the risks of unsafe or inappropriate care and treatment.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' 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. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Policies and procedures had been developed by the registered provider (Warrington Community Living) to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

We were informed that two people using the service had been assessed as lacking capacity to make decisions although no applications had needed to be submitted to deprive a person of their liberty. Training records highlighted that the majority of staff had completed Mental Capacity Act training however only three staff had completed Deprivation of Liberty Safeguards training. This has been brought to the attention of the provider so that action can be taken to increase staff knowledge and understanding.

The provider had developed guidance on recruitment and selection to provide information to staff on the procedures for recruiting new employees. We looked at a sample of recruitment records for three staff which had been stored electronically. Examination of records and discussion with staff confirmed staff had undergone a comprehensive recruitment process prior to commencing work with the provider.

Is the service effective?

Feedback received from people using the service was generally positive and confirmed people were happy with the standard of care provided. Comments included: 'I love living here. I'm much happier since coming here.' Likewise, in relation to meals, one person reported: 'The food is great' and another confirmed the food was nice and tasty by replying 'yes' to the question.

Two relatives spoken with were also complimentary of the standard of care provided. Comments received included: 'The care has been excellent. They are very caring and understanding'; 'The meals are lovely' and 'They do all they can.'

We also sought the views of five health care professionals who visited the property during our visit. All feedback received was positive with the exception of one concern. It had been identified that a resident who had recently returned from hospital had an unexplained knee injury. This had been quickly noticed by the staff on the same day and reported promptly and correctly as a safeguarding issue.

Is the service caring?

On the day of our visit the general atmosphere in the home was calm and relaxed. The people living at the property were observed to be comfortable and relaxed in their home environment and were able to follow their own plans and preferred routines. Staff were attentive to the diverse needs of the people living in the property and were noted to communicate and engage with the people they supported in a respectful, dignified and caring manner.

Is the service responsive?

The registered provider (Warrington Community Living) had developed a corporate complaints procedure. Likewise, an easy read 'service user complaints procedure' and a 'complaints and comments' booklet had been produced to provide people using the service and / or their representatives with information on how to provide feedback on the service provided.

No complaints or allegations were received from people using the service or their representatives during our visit and records highlighted that there had been no complaints in the last twelve months.

The representative of one person spoken with lacked awareness of how to raise a concern. This has been brought to the attention of the provider so that action can be taken to raise awareness.

Is the service well- led?

The provider has worked well with the Care Quality Commission and kept us updated on any significant events via statutory notifications. The service also worked well with other agencies and services to make sure people received their care in an integrated and responsive way. For example, during our inspection, five health care professionals visited the property to ensure the holistic needs of the people using the service were met.

The service continued to utilise a comprehensive internal quality assurance system. Overall this was well managed however gaps in the management of records were identified and in need of action. We have issued a compliance action to the provider to ensure people are adequately protected from the risks of unsafe or inappropriate care and treatment.

We attempted to make contact with the relatives of two of the people using the service to obtain feedback on the standard of care provided. We managed to speak with one relative who was complimentary of the service. Comments received included: 'My sister is always happy and smiling'; I can't complain about the service' and 'In my opinion the care provided is good.'

The people living at 53, Twiss Green Lane were observed to be relaxed in their home environment and in the company of the staff team. Staff were seen to carry out their duties in an attentive, respectful and caring manner during the visit.