Background to this inspection
Updated
24 January 2019
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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 10 December 2018 and was unannounced. The inspection was carried out by one inspector.
Prior to our inspection, we reviewed information we held about the service, including previous reports and notifications sent to us at the Care Quality Commission. A notification is information about important events which the service is required to send us by law. The inspection was informed by the feedback from the local authority. We looked at the information sent to us by the provider in the Provider Information Return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection, we met five people living at the home. We spent time observing interactions between people and the staff who supported them. We spoke with the registered manager and two care staff. We reviewed three people's care plans and risk assessments, daily care records, and medicines administration records. We looked at staff rotas and four staff files including their recruitment, training, supervision and appraisal records. We looked at accidents, complaints and safeguarding records, and paperwork related to the management of the service.
Following the inspection, we spoke with two relatives and a staff member. We reviewed the documents that were provided by the service on our request after the inspection.
Updated
24 January 2019
This inspection took place on 10 December 2018 and was unannounced. The service was last inspected on 2 May 2017, where we found the provider to be in breach of one regulation in relation to good governance. The service was rated Requires Improvement. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions effective and well-led to at least good. At the inspection on 10 December 2018, we found the provider had made some improvements and were no longer in breach of the regulation in relation to good governance. However, we found there were issues with staffing and hence, the service remains Requires Improvement. This is the third consecutive time the service has been rated Requires Improvement.
The Hoffmann Foundation for Autism – 18 Marriott Road is a residential care home registered to provide accommodation and personal care support for up to six people who have a learning disability and may have autism, Asperger's Syndrome or display characteristics that fall within the autistic spectrum. At the time of our inspection, five people were living at the service.
The Hoffmann Foundation for Autism – 18 Marriott Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
There was a registered manager in place. 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.
Relatives of people who used the service told us people were safe and there were enough staff. However, staff told us there were not enough permanent staff and found difficult to work with different agency staff. There was a lack of continuity for people who used the service.
Staff knew how to identify and report abuse, and escalate concerns outside the service where necessary.
Staff were recruited appropriately to ensure they were safe and suitable to work with people who were vulnerable. People’s medicines were managed safely. Staff maintained clear safeguarding and incidents records. The management learnt and shared lessons with staff to improve when things went wrong.
There were systems in place to assess people’s needs before they moved to the service. People’s needs were met by staff who were appropriately trained. Staff received regular supervision to do their jobs effectively. People’s dietary needs were met and were supported to access ongoing healthcare services. The building was not suitable for people due to accessibility issues and the provider was in the process of moving people to a more appropriate setting. The provider sought people’s consent to care and treatment in line with the legislation and guidance.
Relatives told us staff listened to people and were caring. Staff encouraged people to express their views and supported them to be as independent as they could be. People’s cultural and religious needs were identified, recorded and met by staff. Staff were knowledgeable about the importance of maintaining people’s confidentiality.
People’s care plans were in accessible format and gave staff sufficient information to provide personalised care. People’s care was reviewed regularly and relatives were involved in the process. There were systems and processes in place to respond to complaints and concerns in a timely manner. The provider’s end of life care policy did not include how to assess and support people with their end of life care wishes.
Staff were trained in equality and diversity and treated people without discrimination. The provider welcomed lesbian, gay, bisexual and transgender people to use their service.
The provider had effective monitoring, auditing and evaluating systems and processes in place to ensure the quality and safety of the service.
People’s relatives spoke positively about the registered manager and they told us they were happy with the service. However, staff told us there was lack of management presence and they did not always feel valued.
The provider sought feedback from people, relatives, and the management worked in partnership with other organisations to improve the care delivery and people's experiences.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 18 Staffing. We have made recommendations in relation to end of life care planning and staff recognition.
You can see what action we told the provider to take at the back of the full version of the report.