Archived: 44 Broad Green Avenue

At our last inspection of the service on 29 June 2016 the service was rated ‘good’ overall and for all key questions. We undertook an unannounced comprehensive inspection on 25 September 2017. We undertook this inspection because we received concerns about whether people using the service were adequately protected from abuse. At the time of inspection there was an ongoing safeguarding investigation and police investigation due to the concerns raised. The outcome of which could not be considered as part of this inspection.

The registered manager remained 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.

Risks to people’s health, safety and welfare had not been adequately assessed and mitigated. We found risk assessments did not contain detailed information about how risks were to be mitigated and there was some conflicting information in the risk assessments completed. The provider had not sufficiently protected people from environmental risks. The registered manager had not protected people from the risk of burns from hot water or uncovered radiators, or protected people from accessing harmful chemicals as these were not stored securely.

Staff were not up to date with their required training meaning there was a risk that staff’s knowledge may not be in line with good practice guidance. We also saw some staff had not completed training related to people’s specific needs including epilepsy and autism which may impact on their ability to support people with these needs.

Staff did not always adhere to the principles of the Mental Capacity Act (MCA) 2005. There was a lack of information about what aspects of their care people had the capacity to consent to. Where staff felt people did not have the capacity to understand certain decisions, there was no information relating to MCA assessments or best interests’ decisions. Staff had not applied to lawfully deprive a person of their liberty when they required this level of support in order to safe.

Accurate, complete and contemporaneous records were not maintained in regards to people’s care. Care records were not always regularly reviewed and updated in line with changes in people’s needs. The records lacked information regarding the level of support people required and how this was to be delivered.

Robust and effective systems were not in place to review the quality of service delivery and ensure timely and appropriate action was taken to address any concerns identified. Sufficient systems were not in place to mitigate risks to people’s health, safety and welfare. The provider’s policies were not regularly reviewed and updated.

Staff knew the people they were supporting and provided them with the support they required. They encouraged people to develop their skills and to become more independent. People participated in a variety of activities in line with their hobbies and interests, and where able were supported to undertake work opportunities. Staff were aware of how people communicated and enabled them to make choices about how they spent their time.

Staff supported people to access healthcare services and accompanied them to appointments. Staff were aware of people’s dietary requirements and enabled them to eat and drink sufficient amounts to meet their needs. Staff assisted people with their medicines and people received their medicines as prescribed.

There were sufficient staff to meet people’s needs and provide them with the level of support they required. Staff were aware of their responsibility to safeguard people from avoidable harm and were aware of the reporting procedures if they did have concerns about a person’s safety. Staff supported people to raise any concerns about their care and a process was in place to record, investigate and respond to any complaints made.

There were processes in place to obtain staff, people and their relatives’ views about the service through regular meetings and completion of satisfaction surveys.

At the time of inspection the registered manager was aware of their requirements of their CQC registration responsibilities in regards to the submission of statutory notifications. We had received notifications about recent events, including allegations of abuse and incidents involving the police.

We found the provider was in breach of legal requirements relating to safe care and treatment, need for consent, staffing and good governance. After the inspection we contacted the provider asking what action they had taken to address the concerns raised. They provided us with information and evidence of the action taken to address some of the concerns raised which showed some of the risks identified at time of inspection had been minimised. We took this information into account when deciding what action we took. You can see what action we have asked the provider to take at the back of the report.

44 Broad Green Avenue (known as Conifers) provides accommodation and personal care for up to six people with learning disabilities. At the last inspection in August 2014 the service was meeting all the regulations that we assessed.

There was 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.

People using the service felt safe and well cared for. There were clear safeguarding procedures in place; staff were trained and competent in following these. Staffing numbers on each shift responded to individual and collective needs and helped make sure people were kept safe. Risks to people’s safety and welfare were identified and support plans were in place to manage these appropriately. Safe practice was followed for managing and administering medicines to people.

Staff had the knowledge and skills to meet people’s care needs. They attended relevant training to ensure their skills were up to date. Staff received the support required and had regular supervision and appraisal meetings to support them in their role. Staff worked within the principles of the Mental Capacity Act 2005 (MCA) which meant that people received assistance to make their own decisions when needed.

The service had a stable staff team and experienced few changes to personnel. People had developed excellent relationships with staff based on trust and reliability. Staff respected the feelings of the people and supported people to develop positive relationships. Staff knew people’s preferences and supported them to make choices according to what they wanted.

People chose what they wanted to eat and drink, and staff supported them with shopping for and cooking meals. People were supported with health appointments and received professional support as appropriate from health professionals.

The service had a suitable system for dealing with complaints which people were familiar with.

People integrated well in the local community and were encouraged to attend activities of their choice. Staff encouraged people to learn new skills and helped them to maintain the skills they already had.

The service was well led by an experienced manager who monitored the quality of care provided for people and made changes to improve where appropriate.

As part of this inspection we spoke with three people who lived at the home, two members of staff and the registered manager. We looked at records relating to the management of the home which included five care plans, daily care records and records about the training and supervision of staff. We looked at how the service monitored its own performance and the quality of care provided.

Is the service safe?

We found sufficient staff were available to deliver people's care and support needs and they received the training required to provide safe, appropriate care and support. Appropriate checks were carried out before staff started working with people to ensure they had the appropriate knowledge, skills and experience to meet people's care and support needs.

Staff had good knowledge of risk management plans in place to support people's individual needs.

The provider had an effective system in place to analyse any incidents that occurred when providing care and support for people in their homes. The registered manager demonstrated how concerns were investigated with necessary actions identified, taken and followed up. Records were accurately maintained, which meant the risk of people receiving unsafe care was minimised.

Is the service caring?

People told us they were treated with respect and dignity by the staff and they felt safe in the service. We found people were supported appropriately and sensitively by kind and considerate staff. We spoke with staff who told us about how they provided care and support. People we spoke with were very positive about the staff members supporting them. One person told us, 'Everybody here is really nice to me. It's like a family.'

Is the service effective?

People's health and care needs were assessed with them. We saw evidence to show people and their relatives or advocates had been involved in writing and agreeing their care plans. Specialist dietary and healthcare needs had been identified in care plans where required. People we spoke with and their relatives told us they received the support needed. People's care was subject to review so staff could ensure their needs were being met effectively.

Is the service responsive?

Staff we spoke with demonstrated they would report any concerns to the registered manager and were confident these would be addressed. This was confirmed by a person who used the service telling us, relative we spoke with who told us, 'If I've got a complaint I just tell (the registered manager) and they'll sort it out for me.' We saw there was an effective complaints procedure in place.

We found the provider responded appropriately if a person's care and support needs changed, for example, if they became unwell.

Is the service well led?

People we spoke with, staff and relatives were positive about the management of the service. Staff told us they felt supported by the registered manager and other office staff.

We found monitoring and reviews of the service were carried out regularly and highlighted actions were completed in a timely manner.

We spoke to four people using the service. They told us there were regular service users meetings where they were able to discuss things that happened at the home and other issues that were important to them. They told us that they could speak to the registered provider and staff about what happened at the home and knew that what they said would be taken on board.

They told us they had care plans and they had discussed their care and support needs with their key workers. They told us that staff treated them with respect and dignity and their privacy was always respected.

They told us they lived in comfortable surroundings.

All of the people we spoke to told us they knew about the home's complaints procedure. They said if they had any concerns they would tell staff or the manager and they would do something about it.