3 The Causeway is a three storey house situated in a residential setting close to local facilities including a shopping complex, restaurants, a cinema and a bowling alley. The home’s ground floor comprises a kitchen dining room and a separate laundry area. The first floor has one bedroom, a lounge and an office, the third floor has two bedrooms with en-suite facilities. At the time of the inspection there were three people living in the home.
This inspection was unannounced; it took place on 13, 20 and 27 February 2015. At the last inspection on 19 November 2013, the registered provider was compliant with all the regulations we assessed.
The service had a 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.
People were not always protected from abuse and avoidable harm. Incidents of violent and aggressive behaviour were not always reported to the Care Quality Commission or the local authority safeguarding team as required. Investigations were not always completed; care and support plans were not updated to prevent future incidents taking place. We found that [the registered person had not protected people against the risk of abuse and avoidable harm. This was in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
A quality monitoring system was in place that consisted of audits, checks, monthly assessments and stakeholder surveys. We saw that when shortfalls were noted; action was taken to improve the service as required. However, the system required developing to ensure all shortfalls in care, treatment and support were highlighted as incidents of violent and aggressive behaviour that took place within the service were not always addressed or managed.
A formal supervision process was not in place which led to staff not receiving supervision and support as required. When we asked staff if they felt supported we received mixed responses.
The people who lived at the home had complex needs which meant they could not tell us their experiences. We used a number of different methods to help us understand the experiences of the people who used the service including the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who could not talk with us.
People had their health and social care needs assessed, support plans were developed which stated how staff should provide care and support using the least restrictive options. People were treated with dignity and respect throughout the inspection.
We saw that staff gave encouragement to people who lived at the home and supported them to make choices about their daily lives.
Staff were aware of people’s preferences for how care and support was to be delivered. We observed staff gaining people’s consent from non-verbal cues before support was provided. We witnessed staff giving encouragement to people and supporting them to make choices about aspects of their daily lives.
Staff did not always have the skills to communicate effectively. Although staff understood people’s non-verbal communication; what people were trying to convey with sounds and actions was not recorded accurately in a communication support plan.
People were supported to maintain a healthy balanced diet. When required, relevant professionals had been contacted for their support and guidance in this area.
Medicines were ordered, stored, administered or disposed of safely. Personalised support plans had been developed to ensure people received the medicines in line with their preferences and needs.
People were supported by suitable numbers of adequately trained staff who had been recruited safely. We saw evidence to confirm staff had completed a range of training deemed as mandatory by the registered provider.
Staff followed the principles of the Mental Capacity Act 2005 when people lacked capacity to make informed decisions. We saw evidence that best interest meetings were held accordingly. We found the home was meeting the requirements of the deprivation of Liberties safeguards (DoLS). These safeguards provide a legal framework to ensure that people are only deprived of their liberty when there is no other way to care for them or safely provide treatment.
People were supported by staff to undertake a range of social activities in the home and the local community.