25 September 2017
During a routine inspection
At the last inspection in March 2017 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The breaches were:-
Regulation 9 Person-centred care
Regulation 11 Need for consent
Regulation 12 Safe care and treatment
Regulation 13 Safeguarding service users from abuse and improper treatment
Regulation 14 Meeting nutritional and hydration needs
Regulation 17 Good governance
Regulation 18 Staffing
Following our last inspection we asked the provider to take action to make improvements. During this inspection we found improvements had been made and there were no continued or new breaches of regulations.
There was not 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. The provider had secured the services of a manager consultant with a background in mental health. Arrangements were in place to appoint a new manager and candidates were due to be interviewed on 28 September 2017.
People had care plan documents which were accurate, up to date and regularly reviewed. We found these described people’s individual needs and provided staff with a profile of people’s mental health needs. Where risks to individual people had been identified we found staff had been given guidance and advice on how to mitigate these risks.
Staff had been trained in safeguarding vulnerable adults. They told us they felt able to speak to the manager if they had any concerns
There were enough staff on duty. A new board on the wall told people who used the service who were their staff member for the day.
Staff provided appropriate support to people with dignity and respect. We found changes had been made in the service which promoted people’s independence.
Pre-employment checks were carried out on staff to ensure they were of suitable character and had the necessary skills to care for vulnerable people. Staff completed an induction when they first started work which supported them to get to know the home and people who used the service. Staff received regular supervision, appraisals and training. Staff had recently registered to undertake training in mental health.
The provider had used the knowledge and skills of a manager from another service to implement a programme of checks which ensured people were protected from living in an unsafe environment. These included, for example, fire safety and water temperature checks.
Accidents and incidents were recorded by staff. These were monitored by managers to ensure the right actions had been taken and prevent the same type of accident happening again.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Some people in the service were provided with additional staff hours to support them to carry out activities of their choice. Staff had begun to engage with people about the type of activities they would like to see provided.
Staff had completed food and fluid charts to monitor the food and fluid intake of people were at a nutritional risk. People made positive comments about the meals and we found people had a menu choice. Alternatives were available if people preferred other options.
We saw discussions had taken place with mental health professionals. The staff had made referrals to other health care professionals when they assessed people required addition support. We saw referrals had been made to dieticians, the speech and language therapy team (SALT), GP’s, community nurses and community psychiatric services. Systems and processes were in place to monitor and improve the quality of the service. We saw the senior management team had visited the service and carried out audits of the home which resulted in actions being required to improve the service.
A recent survey had been put in place and some survey returns were still expected by staff. The responses received at the point of our inspection were largely positive.
Since our last inspection there had been no complaints made about the service. We saw people had been given information on how to make a complaint. People told us they felt able to make a complaint to staff should the need arise.
People’s medicines were administered by staff who had been trained to carry out these tasks. Staff were required to undertake training before being assessed as competent to give people their medicines. We found people’s medicines were stored securely and regular audits were in place to ensure medicine counts were correct.
Since our last inspection improvements had been made to both the internal and external property. Following our last inspection a fire officer had visited the premises and recommended improvements to fire doors. We found these improvements had been carried out.