Admirals Rest

Admirals Rest is a residential service providing personal care for up to 6 people with mental health support needs. The service consists of one adapted building, which includes individual bedrooms and communal spaces and an accessible garden. At the time of our inspection there were 5 people using the service.

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

People and their relatives told us people felt safe with the care and support they or their relative received. However, despite some positive feedback, we found concerns with environmental risks, staff recruitment and management oversight which placed people at increased risk of harm.

The provider had systems in place to monitor the quality and safety of the service, however they did not identify and address the issues we found during the inspection.

Safe staff recruitment procedures were not being followed.

Environmental risks were not always safely managed. Risk assessments in place identified and assessed risks associated with people's care and support with guidance for staff to follow.

People received their medicines safely and as prescribed. Staff had received safeguarding training and were able to demonstrate an understanding of their responsibility to report any concerns.

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.

The registered manager sought the views of people using the service. Staff told us they were well supported. People and their relatives told us they were satisfied with the service.

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

Rating at last inspection

The last rating for this service was good (published 17 January 2019).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted due to concerns received about safeguarding. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with environmental risks and premises, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Admirals Rest on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in regulations relating to environmental risks, staff recruitment and management oversight at this inspection. We made a recommendation about the maintenance of the premises.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve in specific areas. At this inspection, we found that necessary improvements had been made.

Admirals Rest 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.

Admirals Rest is registered to provide care for up to five people with mental health needs. At the time of our inspection there were five people living there. Admirals Rest is situated in a large terraced house close to the centre of Bridgwater. The communal areas of the service were all on the ground floor. This included a lounge, dining area and kitchen. Bedrooms were available on all floors, and most bedrooms were en suite.

There was a registered manager employed at the service. 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 and their relatives were complimentary about the service, the care received, and the staff team. People were asked for their consent and were supported respectfully.

Staff had received training in safeguarding, and knew what they must do to protect people from abuse or neglect. Systems and processes were in place to protect people from harm and to support staff and the provider had made safeguarding referrals to the local authority appropriately.

The provider ensured that there were enough staff to meet the needs of people, and followed effective recruitment procedures to ensure prospective staff were suitable to work in the service.

There was regular monitoring of fire safety, infection control, incidents and accidents as well as regular equipment checks and maintenance. This ensured the premises and equipment were safe, and risks to people were minimised.

People's medicines were safely ordered, received, stored and disposed of, and were administered as prescribed. Medicines administration records were accurate and clear. Some staff required medicines training or updates.

People were supported to make sure their health and wellbeing needs were met. People’s care records contained personalised risk assessments. These gave staff information about how to support people and ensure risks were managed effectively.

Care records described how people wished to be supported and some personal preferences. People were encouraged to be involved in planning their care and treatment. Where appropriate, relatives told us that they were consulted with and informed about people’s care.

Systems were in place to monitor and review the quality of the service. Audits were up to date, but some were brief. In these cases, the information recorded did not support the provider to make effective quality improvements.

The staff team had recently changed and some staff were new to the service. An induction programme was in place, although staff gave mixed views about this. Staff were caring and patient, and most knew people well. Most staff told us that they received relevant training and support to equip them to carry out their duties effectively.

Admirals Rest provides personal care and support for adults with mental health needs and / or mild learning difficulties. The home is situated within easy reach of the town centre of Bridgwater, Somerset. There are five large, single bedrooms with en-suite or private facilities. There is a communal lounge and dining room; main kitchen; laundry facilities and a sheltered smoking area within a secluded rear courtyard area. At the time of our inspection there were five people living there.

There is 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.

People were not protected from the risk of abuse. Where allegations or concerns had been brought to the registered manager’s attention they had not worked in partnership with relevant authorities to make sure issues were fully investigated and people were protected. The provider did not follow safe recruitment practices; checks had not always been made to ensure staff were suitable to work with vulnerable adults.

Systems and processes around medicines were not reliable and appropriate to keep people safe. Monitoring the safety of these systems was not robust. The registered manager undertook spot checks to review the quality of the service provided, however these did not identify the shortfalls we found.

Staff did not have written guidance how to support people in the event they would need to evacuate for an emergency. Staff had not taken part in fire drills to check they were able to meet people’s needs in an emergency. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff did not have their competency to administer medicines checked and some improvements to medicines management were needed relating to records and storage. Whilst staff received an induction into the service and other additional training, some specific health related training had not been provided.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the manager and provided feedback on the service.

We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 during our inspection. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.