Peripatetic Service - Sherwood Court

Peripatetic Service – Sherwood Court is an extra care housing scheme providing personal care and support to 23 people at the time of the inspection.

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.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People spoke positively about the service. They felt it was safe and staff were caring. People told us, "Staff come to see me and they are always nice and friendly” and, “I’m very safe, it’s a very nice place to be, with lovely staff."

Each person's care needs had been reviewed and documented. Staff had access to risk assessments, carried out to ensure people received safe care. Pre-employment checks such as references had been sought to ensure staff were suitable to support people. Systems were in place to prevent infections. Medicine care plans described people's prescribed medicines and creams and dosages. Staff had access to personal protective equipment and were aware of their responsibility to minimise the spread of infections.

The service was well led. The registered manager promoted an open and honest culture. Effective quality assurance processes were in place. People and relatives were consulted about the quality of the service through surveys and meetings. Staff were involved in the development and improvement of the service through regular meetings.

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

Rating at last inspection and update

The previous rating for this service was Requires Improvement (published 14 August 2019).

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an announced comprehensive inspection of this service on 10, 11 June 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions 'Is the service Safe and Well-led?' which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. 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 Peripatetic Service - Sherwood Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

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

The care plans and daily notes were not always person centred and tended to be task driven. Care plans and risk assessments were in place but the information was limited. There was a risk people would not receive consistent care.

The care record audits of both the provider and registered manager did not look at the care plan and risk assessment details but focused on the layout.

People had their needs assessed prior to the service delivering care and care was reviewed on an annual basis.

People told us they were involved in their care and had regular reviews. This was confirmed in people’s care records.

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.

People told us staff encouraged them to be independent and treated them with dignity and respect.

Complaints were responded to and investigated appropriately.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 October 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection although improvement had been made, there was not enough improvement in relation to one breach of regulation. The provider was still in breach of regulations.

This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

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

Enforcement

We have identified breaches in relation to the quality of the service not been sufficiently assessed and monitored at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

People using the service lived in their own flat in a purpose built complex and had access to care and support 24 hours a day, seven days a week. There was a communal dining area for people to use at lunchtime if they wished.

A registered manager was in post at the time of 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.

PRN, ‘when required’, protocols were not in place to guide staff as to when these medicines should be given. Systems and processes in place to manage medicines were not always safe or effective. We found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Risks associated with people's care were identified and managed. However, we found one instance where a risk assessment was not in place for a person with challenging behaviour.

People were supported by sufficient numbers of staff to meet their needs. Staff underwent appropriate checks prior to starting work. Staff received an induction, regular supervision and training.

The service followed the principles of the Mental Capacity Act. However, we made a recommendation to ensure the information regarding best interest meetings, capacity assessments and Lasting Power of Attorney documentation, to support relative’s involvement, were clearly recorded within people’s care records.

It was clear staff knew people well. People told us they felt involved with their care. We saw people had service user guides within their homes. We saw there was clear guidance in care plans around people’s communication needs. People’s privacy, dignity and independence was respected. We observed staff knocking on people’s doors and waiting to enter.

People’s care plans and daily notes were not always person centred and had a tendency to be task driven. We made a recommendation that the provider looked at ways to ensure people’s care plans were person centred and people’s wishes around their end of life care was recorded.

The provider had a complaints policy and procedure. People were aware of how to make a complaint. Any complaints and outcomes were recorded individually on a person’s contact journal. This made it difficult for the registered manager to maintain an overview of complaints.

Staff were happy working at Sherwood Court and felt listened to by the management team.

The registered manager and provider did not have sufficient quality assurance systems in place in order to have effective oversight of the service.

We found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

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