Redroof House is a domiciliary care agency (DCA) that provides personal care for up to six people who have a learning disability within a supported living scheme. The supported living scheme is located in Epsom and is a short walk from shops and other local facilities. On the day of the inspection five people were being supported. The people have a range of needs and are supported with a full range of aspects of their lives, including maintaining their health and well-being, personal care and support to ensure they have enough to eat and drink. On the day of inspection we met the 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.
The inspection took place on 13 January 2017 and was announced.
We found three breaches of the regulations and have made three recommendations. You can see what action we told the provider to take at the back of the full version of this report.
We found a lack of managerial oversight of people’s overall support. We found examples where concerns with people’s support had not been identified by the registered manager. This put people at risk of not receiving the support they needed. The provider had failed to submit information in the form of relevant notifications and a PIR to CQC. This had an impact on us being able to monitor and regulate the service effectively. These were breaches of the regulations.
The requirements of the Mental Capacity Act (MCA) were not being met. The registered manager had not assessed people’s capacity and was unclear on who had the legal right to make decision on behalf of people who lacked capacity. Although consent for support was sought staff had a limited understanding of MCA and DoLS. The provider had submitted incorrect DoLS applications.
Although responsibility for DoLS applications falls to the funding authority the registered manager had not followed this up. There was no evidence the funding authority were aware of restrictions in place at Redroof House. On the day of inspection some people were being unlawfully restricted as the right processes had not been followed to allow the front door to be locked. This was a breach of regulation.
Staff felt they had the knowledge and skills to support people with learning disabilities and said they understood how to support people who may become anxious and distressed. Despite this there was no formal training or detailed guidance on how to support people when they became distressed and anxious. We recommended that these areas are reviewed in line with best interest guidance and people’s needs.
People said they were treated with dignity and respect and we saw examples of this during the inspection. Despite this there was a one off incident where a person’s privacy was not upheld. Care plans were sometimes written in an undignified manner. We have recommended the provider makes improvements in these areas.
People and relatives said that Redroof House was a safe place to live. Staff understood how to report suspected abuse so that action could be taken if necessary.
Incidents and accidents were reported and the registered manager who reviewed reports to prevent them from re-occurring and implemented actions where necessary to reduce the risk of harm to people. When risks to people had been identified they were appropriately managed. People had risk assessments that staff followed to minimise risk and keep people safety.
People were supported by sufficient numbers of staff who were recruited safely and had the right to work in the UK.
People received medicines in a safe way. Staff had a good understanding of the medicines they were supporting people to take and medicines were stored and disposed of appropriately.
Staff had regular supervisions with their line manager and felt supported in their role. The registered manager used supervisions and team meetings to ask supportive questions of their team to assess their knowledge.
People’s nutritional needs were met and people had a varied diet. Staff ensured that people had enough to eat and drink. Staff ensured people were supported to maintain their health and wellbeing and people received support from healthcare professionals when required.
People were cared for by staff who were compassionate and kind. People were not rushed by staff. People were encouraged to maintain relationships with their family and those that mattered to them.
People were encouraged to be involved in how the service was run and people and relatives felt comfortable in raising a concern or making a complaint. Feedback from people and relatives was asked for on an annual basis. This feedback was very good.
The home was led by a registered manager who was a positive role model. An organisational value of providing support that ‘fulfilled potential’ was understood by the staff team. The registered manager was approachable and visible. Relatives and staff said they would approach her if they had any concerns.