All inspections: 30 Coleraine Road - Care Quality Commission

This comprehensive inspection took place on 9 March 2017 and was unannounced.

At our last focused inspection in April 2016 we found breaches of legal requirements in relation to staffing levels. Staffing levels were not adequate to manage individual risks in the community and at the home.

30 Coleraine Road is a care home providing care and support to up to four adults with learning disability and mental health needs. Each person has their own room and there is a communal lounge and dining areas. At the time of our inspection there were two people using the service.The provider had three services within close proximity.

At the time of our inspection a new manager had been appointed and planned to apply to become the 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.

At our last inspection we found staffing levels were not sufficient to meet people's needs. During this inspection we saw that the service had appointed a floating support worker to work across the services when additional staff were needed.

Records relating to people using the service were not always accurate and updated. At our last inspection in April 2016 we found health action plans (HAP) also known as 'my purple book' (book containing up to date information about peoples’ health needs) were not always up to date. During this inspection we found this was still an issue. Risk assessments were in place, including triggers to observe and how to manage any risks posed. However, we found that risks were not always recorded.

People were protected from the risk of abuse because staff were knowledgeable and knew what action to take to protect people. Staff were subjected to the necessary checks to ensure they were safe to work with people.

People were treated with dignity and respect and their privacy respected. During our inspection we saw that staff spoke to people in a respectful manner and respected their opinions.

Care plans documented peoples likes and dislikes and preferences for care.

We found breaches relating to consent to care and treatment, one person did not have a DoLS authorisation in place. Systems for monitoring the quality of the service were not effective in ensuring that records relating to people using the service were accurate and up to date.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced focused inspection on 15 April 2016. We last inspected the home on 29 July 2015 and 30 July 2015 and breaches of legal requirements were found. This was because we found that recruitment of staff was not always safe and there were not always effective systems in place to ensure records were accurate and of a good standard. We received an action plan from the provider stating that these issues would be addressed.

We undertook this unannounced focused inspection of 15 April 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this matter. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for 30 Coleraine Road on our website at www.cqc.org.uk.

30 Coleraine Road is a care home providing care and support to up to four adults with learning disability and mental health needs. Each person has their own room and there is a communal lounge and dining areas. At the time of our inspection there were four people using the service.

At the time of our inspection the registered manager was on leave. 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.

During this inspection we saw that some improvements had been made. Health action plans (HAPs) had been updated to include recent visits to healthcare professionals. However, we found that further improvements were required to ensure that all healthcare visits and outcomes were recorded in people’s hospital passport ‘my purple book’. There were improvements to recruitment practices and a newly appointed operations director had been appointed to review the quality of the service including care records and service delivery. However, we were concerned about staffing numbers in relation to risk management.

We found the provider was in breach of the Regulations relating to staffing.

You can see what action we asked the provider to take at the end of this report

This inspection took place on 29 and 30 July 2015 and was unannounced.

30 Coleraine Road is a care home providing care and support to up to four adults with learning disability and mental health needs. Each person has their own room and there is a communal lounge and dining areas. At the time of our inspection there were four people using the service.

The registered manager had been in post since June 2014. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At our last inspection in July 2014 we found breaches relating to medicine management, standards of cleanliness, maintenance of the building, staffing numbers, staff support and quality assurance. People were put at risk of unsafe premises because the service had not maintained standards relating to the building, cleanliness and hygiene and medicines were not managed safely. We also found that staffing numbers were not sufficient to meet peoples’ needs. We asked the provider to take action to make improvements. We received an action plan from the provider stating that these actions would be completed by end of January 2015. We saw that most of these actions had been completed.

During this inspection we found that the provider had made improvements as outlined in their action plan. We saw that the provider had made improvements to the environment. We saw that the environment was clean and safe for people living at the home and window restrictors installed on upper floor level windows. The provider had created an office for staff and a phone installed. Therefore people and staff had access to make calls in an emergency. However, topical medicines such as creams were not properly managed and staff did not know what people’s medicines were for. Staff had started to review the person centred plans (PCP) for people living at the home. This involved other healthcare professionals and relatives. We made recommendations for the service to consider Department of Health (DoH) guidance on Health Action Plans and Hospital Passports. This had been followed up by the registered manager, but further work was required to ensure that these were fully completed.

Although most staff said they felt supported by the new manager, some staff did not feel they had the support they needed.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

This inspection was unannounced. At our last inspection in December 2013 we found the service met all the regulations we looked at.

30 Coleraine Road is a care home providing care and support to up to four adults with learning disabilities, autism and mental health. Each person has their own room and shares a communal lounge, kitchen, bathroom and dining area. At the time of our inspection there were four people using the service.

At the time of our inspection the service did not have a registered manager in place. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The manager had been newly appointed in June 2014 and had yet to submit an application to CQC to become the registered manager.

We spoke with two people living at the home. One person told us, “I feel very safe.” Another person said, “its ok here.” One relative felt their relative was not safe living at the service.

During this inspection we found a number of breaches relating to cleanliness and infection control, management of medicines, staffing numbers and quality monitoring of the service.

People were at risk of acquiring a healthcare related infection because the provider had not taken appropriate steps to ensure the home was clean. For example, there were no hand washing gel or paper towels in communal bathrooms for people to wash and dry their hands. The communal stairway was dirty and unkempt. We found that the home was inadequately maintained, for example one first floor bathroom did not have a window restrictor. This put people at risk of falling out of the window.

People’s medicines were not stored safely and appropriately disposed of appropriately. We saw that medicines were stored in an area which had poor lighting. This made it difficult for staff to read people’s prescribed medicine. The medicine cupboard was not secured to the wall and medicine no longer required were kept on the floor inside and outside of the cupboard and had not been disposed of.

Staffing numbers were not sufficient to meet people’s needs. Staff told us that there was not enough staff to take people out into the community. On the day of our inspection we saw that people who required one to one care at all times were not always provided with this.

Systems for monitoring the quality of the service were not effective, because audits conducted by the provider had failed to identify the issues found on the day of our inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

In this report, the name of two registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a registered manager on our register at the time of inspection.

We spoke to people who used this service. A person said "I am very happy here" and "I have a nice home and a nice TV in my room". Another person told us that staff helped them to be involved in making decisions about their life. This person said "Staff listen to what I say". We also spoke to relatives of people who used this service. A relative told us "Generally, everything is fine" and "There are no real issues". Another relative told us of their relative "He seems to be very happy" and "He says he is very happy" and, in relation to the support provided to their relative, "Staff are always nice". Both relatives mentioned the change of manager which had taken place; one told us they had been notified of this quite well, whereas the other relative stated that they were not well notified of this change.

We also spoke with staff who worked at this service. A staff member told us "People who live here receive safe and effective support". Staff told us that there was an open and positive culture at this service. We were told "If there are any issues, staff always talk to the manager to work towards sorting out issues". We observed staff working positively with people who used this service and to have treated people with respect and dignity.

We found that people's consent was considered in relation to their treatment and support. People were involved in a discussion about their treatment and support and were asked to confirm that they agreed with it.

We found that people received care which ensured their welfare and protected them from risks.

We found that there were effective systems in place to ensure that this service was clean and that any infections would be controlled.

We found that all the equipment and furnishings at this service were safe for people to use.

We found that there were sufficient staff available to effectively meet people's needs.

We carried out this inspection to follow up on concerns found at the previous inspection in May 2012. At the time of this inspection visit three people were living in the home (all of whom had lived there for several years). They were supported by a staff team who also supported people living at 37 Coleraine Road. We only met with two of the residents, as one person was out at supported employment during the visit.

People experienced care, treatment and support that met their needs and protected their rights. Improvements had been made regarding records of support provided to people with their finances, and regarding support to help address their individual goals. One person living at the home told us "It's going very well."

People we spoke to were positive about the support they received, and told us that they were provided with the care that they needed, and were given choices. They had formed good and supportive relationships with staff and management. They told us that they liked the food, and had opportunities to go out as often as they wished. They described a number of activities available to them within and outside of the home including jogging, swimming, dance, yoga, football, and meals out. Each person had an individual activity plan in place for them. Two of the residents had attended the paralympic games and enjoyed a trip to the seaside over the summer.

There had also been an improvement in the home's quality assurance procedures to ensure that when improvements were needed these were put in place without delay.

At the time of the inspection visit three people were living in the home (all of whom had lived there for several years).

We spoke with all of them, and they told us that they were receiving the care and support that they needed, and were given choices. They had formed good and supportive relationships with staff and management. One person noted 'the staff are good - I like it here.'

They told us 'the food's nice here,' and had all enjoyed a holiday with staff support to Gran Canaria. One person told us 'I do swimming, jogging, gym and football.' Another said 'I go jogging once a week, and play football twice weekly, and I go to dance and yoga classes.' They also told us that they went to a supported employment centre on four days weekly. They said 'we go out some weekends, for bus rides, walks, and to play snooker.' They described a number of activities available to them within and outside of the home, although some felt that they would like a greater variety of activities. There was room for further development of individual activity plans for each person living at the home.

People had access to healthcare professionals when needed, and they received their medication at the prescribed times. Their privacy and dignity were respected and they were protected by appropriate safeguarding procedures.

There was insufficiently clear management of people's spending, and support provided for them to achieve chosen goals. There were also insufficiently rigorous quality assurance procedures in place to ensure that any improvements needed were put in place without delay.

People were positive about the home, indicating that they were provided with the care that they needed, were given choices, and had formed good and supportive relationships with staff and management.

People had access to healthcare professionals when needed, and they received their medication at the prescribed times. They were happy with the food served in the home, and the variety of activities available to them. Their privacy and dignity was respected and they were protected by appropriate safeguarding procedures.

The service had only recently been transferred to the current provider, and it was therefore inevitably an unsettled time for people living and working at the home. However the continuity and consistency of staff working with people at the home, had clearly alleviated this.

A small number of improvements are needed regarding the management of people's finances, and staff training in particular areas.

Archived: 30 Coleraine Road

All Inspections

9 March 2017

During a routine inspection

15 April 2016

During an inspection looking at part of the service

30 July 2015

During an inspection looking at part of the service

July 2014

During a routine inspection

29 December 2013

During a routine inspection

1 October 2012

During an inspection looking at part of the service

18 May 2012

During a routine inspection

2 August 2011

During a routine inspection