Background to this inspection
Updated
4 July 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team:
The inspection was carried out by an inspector, an assistant inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service
Service and service type:
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. This inspection looked at 30 people’s personal care and support who were living in ordinary flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection:
We gave the provider 48 hours’ notice of this inspection. This was to ensure that people using the service were aware of our visit and were given the opportunity to arrange to speak with our inspectors at agreed times.
Inspection site visit activity started on 10 May 2019 and ended on 14 May 2019.
What we did:
On this occasion, we had not asked the provider to send us a provider Information return (PIR). A PIR is a form that asks the provider to give some key information about the service. This includes what the service does well and improvements they plan to make. However, we offered the provider the opportunity to share information they felt was relevant.
During the inspection, we spoke with eight people who used the service and one visitor. We spoke with five members of the care staff and the registered manager.
We reviewed a range of records. This included eight people's care records and three staff files. We also viewed training and supervision records and records relating to the safety and management of the service.
After the inspection, we asked the registered manager to provide us with a variety of policies and procedures and additional information. All information was sent within the required timeframe. We used all this information to help form our judgements detailed within this report.
Updated
4 July 2019
About the service: This service supported 30 people who received some element of support with their personal care within their own flat accommodation. This was the service’s first inspection under its current registration.
People’s experience of using this service:
The provider had not met the characteristics of ‘Good’ in all areas. This has meant the overall rating for this service is ‘Requires Improvement’. We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have also made a recommendation about how the provider can improve how the principles of the Mental Capacity Act 2005 are implemented in people’s care. More information about this is in the full report and can also be found at www.cqc.org.uk
The risks to people’s health and safety were not always appropriately assessed to reduce those risks. This included some risks in relation pressure care, medicines and safe evacuation. People’s medicines were managed and administered safely; however, robust protocols were not always in place for the administration of ‘as needed’ medicines. People felt safe when staff supported them in their home. People were protected by staff who understood how to protect them from avoidable harm. There were enough staff in place to respond to people’s needs and to keep them safe. The risk of the spread of inspection was safely managed. Systems were in place to help the provider to learn from mistakes, accidents or incidents.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice. People’s health was monitored by staff, but this was not always reflected in robust and comprehensively completed records. People were supported to maintain good nutritional health; however, there was limited guidance in place for the monitoring of the diets of people who had diabetes. Staff felt supported to carry out their role effectively and had received training deemed mandatory by the provider for their role. People had access to other health and social care agencies where needed.
People found the staff to be kind, caring and respectful. People were treated with dignity and their independence was encouraged. People felt able to discuss there needs with staff. People’s records were stored securely to protect their privacy.
There was an inconsistent approach to the way people’s personal preferences and choices were considered when care was planned for them. It was not always evident that decisions made for people were in accordance with their preferences. People’s needs were assessed prior to them using the service. Some people received support with rehabilitation with the aim of returning to fully independent living. People had access to information in a format they could understand. Complaints were responded to in line with the provider’s complaints policy. People were not currently receiving end of life care.
Quality assurance processes were not always effective in identifying, monitoring and acting on any risks to people’s safety. There was limited involvement of the provider in ensuring the registered manager was carrying out their role effectively. This meant there was limited focus on continued learning, development and improvement. The registered manager had a good understanding of the regulatory requirements of their role. Some people were unaware who the registered manager was; however, those that did, felt they acted on any concerns they raised. Staff felt able to raise any concerns and the registered manager would act on them. The handover process at times was limited in recorded detail about the care people had received.
Rating at last inspection:
This was the service’s first inspection under its current registration.
Why we inspected:
This was a planned inspection.
Follow up:
We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern we may inspect sooner than scheduled.