Archived: House 2 Slade House

Updated 12 October 2016

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 31 August and 1 September 2016 and was announced. Due to its small size and the type of the service, the provider was given a 48 hours’ notice of the inspection. We needed to make sure that members of the management team would be available and that people who use the service could be contacted in person. The inspection was carried out by two inspectors.

Before the inspection, the provider had completed a Provider Information Return (PIR). 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. We also reviewed all the information we held about the service. This included any statutory notifications that had been sent to us. We also contacted the local authority responsible for monitoring the quality of the service to seek their views. We used this information to help inform our inspection.

During our inspection we spoke with three people living at the service. We also spoke with the manager, two relatives, three members of staff, a social worker and the clinical manager. We observed staff supporting people in the communal areas. We reviewed care plans for four people, recruitment files for four staff members, staff training and supervision records and other records relating to the management of the service.

Updated 12 October 2016

The inspection we carried out at House 2 Slade House on 31 August and 1 September 2016 was announced. The provider was informed about our visit 48 hours in advance. It was a full comprehensive inspection which was also a follow-up to our previous visit in August 2015. House 2 Slade House is registered as a care home offering nursing services and support for up to six people with learning disabilities. There were five people at the service on the day of the inspection. The long-term goal of the service is to enable people to live safely in their communities.

At the last inspection carried out on 6 and 14 August 2015 we found three breaches of the regulations. Staff had not received supervision and appraisal support, and the provider had failed to notify the Care Quality Commission (CQC) of incidents. The service did not have an effective system in place to assess, monitor and improve the quality and safety of the services provided. At this inspection we aimed to see what measures had been taken to ensure the quality of the service had improved and check if these measures had been effective. The provider had told us that all the corrective actions specified in their action plans would have been implemented by the end of March 2016. During our inspection on 31 August and 1September 2016 we found that not all of the recommended actions had been completed.

At the time of our inspection we noted that the service had not had a registered manager in post for the last two months. The acting manager of the service told us they were not going to become registered. 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.

During this inspection carried out in August 2016 we found risks associated with people’s behaviour, identified in risk summaries were not always followed by appropriate risk assessment and management plans. As a result, the service was unable to ensure people received care and support which kept them safe.

Staff shortages were covered by staff from another location of the same provider. Staff from the other location told us they did not always have the time to familiarise themselves with people’s risk assessments and care plans. As a result, the service failed to ensure that all staff were aware of people's needs.

Checks on fire alarms and emergency lighting had not been completed in accordance with the provider’s policy. However, the clinical manager took immediate action to conduct these checks on the day of the inspection and told us they would continue to do so regularly in the future.

Staff received regular supervisions and appraisals. However, some of the staff members did not always find supervisions meaningful and informative. Appraisal documents were incomplete and failed to identify any goals or areas for staff development.

The service had a complaints procedure in place. However, on the first day of our inspection we noticed the policy was not displayed and provided for people to know how to raise a complaint. People had been given opportunity to participate in a survey on the quality of service, but we were unable to see how their feedback affected service delivery.

The provider failed to put effective systems into effect to assess, monitor and improve the quality and safety of the service. Audits undertaken had not identified the issues relating to a lack of risk assessments, health and safety checks, and appraisal records that we found during the inspection.

Records kept by the service were not always available, accurate or complete. Staff’s morale was very low as staff felt devalued and unsupported by the service provider.

Relatives felt their family members were safe and staff knew how to identify different types of abuse as well as who to report concerns to.

People received their medicines safely and staff had been trained to administer medicines in line with the home’s policies and procedures. Staff’s competence was reviewed regularly to ensure safe administration of medicines.

There were sufficient numbers of staff on duty to meet the needs of people who use the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks in the course of the recruitment process. The checks included evidence of identity, criminal record checks, references and employment history.

Staff were suitably qualified and competent in their roles and people confirmed this. Staff received appropriate induction and a range of further training.

People were actively involved in making decisions about their care and support needs. People also decided how they wanted to spend their day. Staff demonstrated understanding of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to maintain a balanced diet and to access healthcare services when required. Staff treated people with dignity, kindness and consideration. People's privacy was respected and people were involved in making day-to-day decisions about the support they received.

Interactions between people and staff were positive. People responded well to staff and felt comfortable and relaxed in the presence of staff members. People were encouraged to take part in the activities they enjoyed and supported to be as independent as possible.

We found multiple breaches of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 CQC (Registration) Regulations 2009 You can see what action we have advised the provider to take at the end of this report.