Archived: HF Trust - No 3 & 4a Milton Heights

HF Trust – No 3 & 4a Milton Heights is a residential care home that was providing support and personal care to five people with a learning disability at the time of the inspection.

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

The purpose of this inspection was to check if the provider had met the requirements of the warning notice. An action plan to address the warning notice carried out by CQC had been implemented. The provider and manager had taken steps to improve the service and ensured people received safer care. The requirements of the warning notice had been met and therefore the provider was no longer in breach of regulation 12 (Safe care and treatment) and regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s individually assessed risks were recorded and dated appropriately. Improvements had been made to ensure people’s environments were kept safe. People’s medicines were safely managed including over the counter medicines.

People’s records had been improved to ensure they were accurate and complete. Staff had been given further training on completing electronic records to ensure relevant information was included.

The governance of the service had improved. This included effective quality assurance such as regular auditing records to ensure they were accurately completed to monitor risk. New systems were in place to ensure all recording was completed clearly by all staff.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 27 April 2019) when there were continued breaches of regulation. Following our last inspection, we served warning notices on the provider and the registered manager. We required them to be compliant with Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 21 June 2019.

Why we inspected

This was a targeted inspection based on the warning notices we served on the provider and the registered manager following our last inspection. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice.

We undertook this targeted inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the safety and governance of the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (published 15 March 2018). We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, responsive and well led to at least Good. At this inspection, the service remained Requires Improvement. This is the second consecutive time the service has been rated Requires Improvement.

Why we inspected:

This was a planned inspection based on previous rating.

People’s experience of using this service:

• The service was not consistently well led. The registered manager carried out quality assurance checks however, they had not identified the areas of concern found during this inspection.

• People did not always receive safe care and support. Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service.

• People were at risk of having their safety compromised. This was because safety checks such as fire drills were not taking place to ensure staff knew what to do in the event of fire.

• Medicines were not always managed safely.

• We found where people lacked capacity and were being deprived of their human rights that the principles of the Mental Capacity Act were not always followed. We made a recommendation that the provider refers to current guidance.

• People’s records had information on leisure and hobbies and how they were to be supported to take part in their interests and activities. However, feedback and records did not reflect these goals as being met.

• There were enough staff with the appropriate training and support to give people the care and support they needed.

• Recruitment arrangements were robust to ensure the right staff were recruited.

• People were protected by the provider's prevention and control of infection procedures.

• People were supported to access health care when needed and sufficient food and drink was available to people throughout the day.

• We observed and received feedback that people were supported by kind and caring staff.

• The service had been developed and was designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure the rating of the service improves to at least Good. We will re-inspect the service within our published timescales to see what improvements have been made. If any concerning information is received, we may inspect sooner.

The service had 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.

Risks to people were not always identified. Where risks had been identified they had not been reviewed or updated to ensure people were supported to stay safe. People’s medicines were not always safely managed as guidance was inaccurate and out of date. People were not always protected from risks in the home environment as the service’s mandatory checks had not always been completed.

People’s physical, mental health and social needs had been assessed. Support plans were up to date and accurate. For one person, there was no record of any individual preferences, interests or aspirations the person may have in their current placement to ensure they had as much choice and control as possible.

Although people’s rooms had been personalised to their choice, the communal areas of the house, decoration and signage were not reflective of any personalisation.

There was a complaints process in place which had followed procedure. We asked, but were not provided with, examples of how complaints had been used as an opportunity to improve the service.

Systems for monitoring and improving the service were not always effective. Auditing systems had not identified the issues we found during the inspection. Incidents were not always investigated to identify actions needed to reduce the risk of further events. The provider did not ensure the necessary improvements were made, sustained and lessons learnt where necessary.

The provider (HF Trust) had clear visions and values. The registered manager showed an awareness of these values and a desire to achieve good outcomes for people. Staff and relatives spoke positively of the management. The staff appreciated the presence of the registered manager in the service to provide direct support. However, we were not assured of the effectiveness of the management of the service as issues found during the inspection had not been identified in the quality assurance processes.

Staff were supported through regular supervisions and had access to development opportunities. Staff completed training to ensure they had the skills and knowledge to meet people's needs. Staff were encouraged to attend team meetings and to work well together as a team.

People’s nutritional needs were met and people had choice and were involved in preparation of meals when able. People were supported to access external health professionals when required.

People and their relatives told us the staff were caring. Staff demonstrated that people were treated with kindness in their day-to-day care and support. Communication methods were explained and staff understood the different ways people communicated. People’s privacy and dignity needs were understood and respected.

People were supported to access a range of activities that they enjoyed and we saw them being supported to attend these during the inspection.

There were systems and processes in place to safeguard people from abuse. Staff were clear about their responsibilities to report any concerns to senior staff and were confident to do so. The provider had recruitment processes in place that ensure people were supported by staff that were suitable to work with vulnerable adults. There were sufficient numbers of staff to support people to stay safe.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of the Care Quality Commission (Registration) Regulations 2009. This is the first time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

The provider had sent us a plan describing what action they would take to ensure that care workers were supported to undertake their role appropriately. During our visit we saw that significant improvements had been made and action had been taken as described.

Systems were in place to ensure that the home met the provider's training requirements. We saw that the home had introduced a new electronic training monitoring system and refresher training had been booked as required.

On 6 September 2013 the provider had reviewed its arrangements for supporting care workers to develop their competency when medication errors had been made. Care workers received additional supervision and manager mentoring for 4-6 weeks following retraining.

The provider had supported care workers to develop an understanding of their responsibilities under the MCA. Training had been provided and care workers had reviewed people's decision making care plans to ensure they could apply their knowledge appropriately.

We saw that the provider had not only taken action to improve the areas we identified at our previous visit. Decision making systems had also been reviewed and additional positive outcomes had been achieved for people when planning their care and making significant decisions.

We found that people's care was planned and delivered in an individualised way. People were supported to communicate and make their wishes known. We found that people's health and social needs were being met. We found that staff did not always understand their duties under the Mental Capacity Act (2005). This included recording all capacity assessments and best interest decisions to ensure that people's rights were upheld when they lacked the capacity to make important decisions.

The home had developed suitable arrangements to protect people from the risk of abuse. Staff we spoke with knew how to identify abuse and how to implement the safeguarding procedure. We found that any identified or suspected abuse was addressed appropriately.

We found systems were in place to ensure the safe management of people's medication. Staff were trained and understood their responsibilities. We saw where medication errors had occurred systems were put in place to minimize the risk of these errors occurring.

Staff received regular training and supervision. We found that the provider identified concerns with staff performance and had taken action. We saw that these concerns were not always addressed through supervision to ensure staff received appropriate professional development additional to training.

We found that systems had been developed to enable the manager to monitor the quality of the service provided and to identify and respond to risks. We thought the provider might want to know that it was not always clear whether these systems were being implemented appropriately.